WorldWideScience

Sample records for care sensitive conditions

  1. AMBULATORY CARE SENSITIVE CONDITIONS: DIAGNOSTIC RELIABILITY IN SOUTHERN BRAZIL

    Directory of Open Access Journals (Sweden)

    Rafael Antoniazzi Abaid

    2014-12-01

    Full Text Available Introduction: Ambulatory Care Sensitive Conditions (ACSC are illnesses that could be prevented with adjusted ambulatorial care. ACSC have been used as indicator in effectiveness of the primary healthcare attention, through the evaluation of hospital admissions. However, we do not have studies to certify the reliability of diagnosis of ACSC in our country. Objective: To determine if the classification of ACSC from the main diagnostic field of the authorization of hospital internment (AHI is reliable. Methods: Transversal study carried through February of 2010 to January of 2011, in the city of Santa Cruz of Sul (RS. A random sample of 389 medical records was selected and evaluated by two medical appraisers. The main diagnosis in the AHI was compared with the classification in ACSC or not ACSC given for the appraisers after the study of each medical record. Kappa ratio agreement was used to calculate the reliability of the ACSC diagnostic. Results: The ratio of agreement between diagnosis from the AIH and CSAP assessment contained in the records was 92%, with a kappa coefficient of 0,784. Conclusions: The diagnostic of ACSC found in main diagnostic field of AHI showed agreement ratios over expected by chance, with kappa value equal to 0.784 and the correlation rated between substantial and almost perfect.

  2. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2011-03-01

    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders

  3. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

    NARCIS (Netherlands)

    Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.

    2013-01-01

    PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c

  4. AMBULATORY CARE - SENSITIVE CONDITIONS IN CHILDREN UNDER FIVE YEARS

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Araújo Figueiredo

    2013-05-01

    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  5. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  6. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  7. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;

    2016-01-01

    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES......: To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality. RESEARCH DESIGN AND MEASURES: Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data...... on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories. RESULTS: Being...

  8. Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil

    Directory of Open Access Journals (Sweden)

    Renata Laszlo Torres

    2014-08-01

    Full Text Available Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC, in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61% by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.

  9. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  10. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  11. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

    Directory of Open Access Journals (Sweden)

    Laditka Sarah B

    2009-07-01

    Full Text Available Abstract Background Federally qualified community health centers (CHCs and rural health clinics (RHCs are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS conditions. Methods We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties. Counties were categorized by facility availability: CHC(s only, RHC(s only, both (CHC and RHC, and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Results Among working age adults, rate ratio (RR comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95. Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87; for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92. No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations

  12. Habituation, sensitization and Pavlovian conditioning

    Directory of Open Access Journals (Sweden)

    Münire Özlem Çevik

    2014-02-01

    Full Text Available In this brief review, I argue that the impact of a stimulus on behavioral control increase as the distance of the stimulus to the body decreases. Habituation, i.e., decrement in response intensity repetition of the triggering stimulus, is the default state for sensory processing, and the likelihood of habituation is higher for distal stimuli. Sensitization, i.e., increment in response intensity upon stimulus repetition, occurs in a state dependent manner for proximal stimuli that make direct contact with the body. In Pavlovian conditioning paradigms, the US is always a more proximal stimulus than the CS. The mechanisms of associative and non-associative learning are not independent. CS-US pairings lead to formation of associations if sensitizing modulation from a proximal US prevents the habituation for a distal anticipatory CS.

  13. Culturally Sensitive Health Care and Counseling Psychology: An Overview

    Science.gov (United States)

    Herman, Keith C.; Tucker, Carolyn M.; Ferdinand, Lisa A.; Mirsu-Paun, Anca; Hasan, Nadia T.; Beato, Cristina

    2007-01-01

    This article introduces the Major Contribution, which focuses on counseling psychologists' roles in addressing health disparities through culturally sensitive health care research and interventions. First, the authors provide a rationale for conducting research focused on culturally sensitive health care and then offer definitions of…

  14. CONDITIONS LIFE OF SENIORS IN RESIDENTIAL CARE

    Directory of Open Access Journals (Sweden)

    Wildmannová Mirka

    2014-05-01

    Full Text Available Residential care for seniors belongs to current trends in now days debate on the quality of life for retirement people. Common problem to all EU Member States is the problem of aging population. European governments are currently addressed to the issue of the quality of life of seniors. Particularly provision of contingencies for outreach, non-resident and residential services – its setting, structure, financing and quality. The target group are seniors, men and women, who live in and use services of facilities residential care. A questionnaire survey was conducted in nine homes for the elderly in the South Moravian Region and 23 questions were included. The 252 respondents participated with the questionnaires. This paper aim is to evaluate the research which was carried out in residential care facilities for elderly. The research question was mainly quality care provided for the elderly and the reason for making the decision about entering this type of sanitary facilities/care-taking institution. All age groups are represented in residential care facilities, half of them receiving the care allowance. All respondents qualified the quality of service as good, and they were satisfied with a range of leisure activities. The research showed that residential care is not a threat to the quality of life of elderly people, but is offering them the conditions for fully spent time with no loss of their dignity. I infer a recommendation that any financial support to municipalities and counties for the establishment of residential housing for seniors is based on the research carried out and it is as well the right recommendations for future conception of housing in old age.

  15. Unmet health care needs for persons with environmental sensitivity

    OpenAIRE

    Gibson PR; Kovach S; Lupfer A

    2015-01-01

    Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions ...

  16. Unmet health care needs for persons with environmental sensitivity

    Directory of Open Access Journals (Sweden)

    Gibson PR

    2015-01-01

    Full Text Available Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions to general anesthesia. Results showed that the most common barriers to receiving care were the inability to find a provider who understands environmental sensitivities and a lack of accessibility due to chemical and electromagnetic exposures in health care environments. Lower income and poorer health (longer illness, a worsening or fluctuating course of illness, and a higher level of disability were significantly correlated with the total number of reported unmet health care needs. Some people with environmental sensitivities reported having negative reactions to anesthesia of long duration; most common were nausea and vomiting, fatigue, and reduced cognitive ability.Keywords: environmental sensitivity, chemical sensitivity, electrohypersensitivity, chemical hypersensitivity, chemical intolerance, contested illness

  17. Primary care patient willingness for genetic testing for salt-sensitive hypertension: a cross sectional study

    OpenAIRE

    Okayama, Masanobu; Takeshima, Taro; Ae, Ryusuke; Harada, Masanori; Kajii, Eiji

    2013-01-01

    Background The current research into single nucleotide polymorphisms has extended the role of genetic testing to the identification of increased risk for common medical conditions. Advances in genetic research may soon necessitate preparation for the role of genetic testing in primary care medicine. This study attempts to determine what proportion of patients would be willing to undergo genetic testing for salt-sensitive hypertension in a primary care setting, and what factors are related to ...

  18. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

  19. Risk factors for latex sensitization among health care workers.

    Science.gov (United States)

    Vila, L; Sánchez, G; Añó, M; Uasuf, C G; Sanz, M L

    1999-01-01

    Health care workers, children with spina bifida and rubber industry workers show higher prevalence of latex sensitization compared to the general population, and they are considered at-risk groups. Our aim was to establish the prevalence of latex allergy among health care workers at the Clínica Universitaria of Navarra and to analyze potential risk factors, including personal and family history of atopy, sex, as well as factors leading to enhanced exposure to latex, such as being a nurse, belonging to surgical departments, having undergone previous surgery and the number of gloves employed per week. Health care workers (n = 1,150) (doctors, nurses, assistant nurses, laboratory technicians and practicing medical and nursing students) were evaluated using a questionnaire and skin prick test (SPT). Serum specific IgE was determined by CAP-FEIA (Pharmacia, Sweden) in those with positive SPT. The participation index was 26.17%: 301 volunteers answered the questionnaire and underwent SPT. Fifteen subjects presented positive SPT to latex. It was found that 5% of the health care workers from the Clínica Universitaria were sensitized to latex allergens. Thirteen were females and two males. Mean age was 38.4 (+/- 7.09) years. Nine were nurses, three assistant nurses, one nursing student and two medical doctors. Eight belonged to medical, five to surgical and two to laboratory departments. There were no significant differences among the subjects in the prevalence of latex sensitization. Fourteen reported symptoms related to latex, mostly pruritus, dryness and/or redness of the hands (n = 12) and rhinitis (n = 6). Only one subject reported no symptoms when using latex products. Eight were atopic; personal history of atopy was the only significant (odds ratio = 5.10, p < 0.01) risk factor for latex sensitization. It was concluded that atopic health care workers show a more increased risk of latex sensitization than those who are nonatopic. PMID:10664929

  20. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees. PMID:26320045

  1. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.

  2. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  3. Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital

    OpenAIRE

    Abrahamsen Grøndahl, Vigdis

    2012-01-01

    There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care...

  4. How do states condition care chains?

    DEFF Research Database (Denmark)

    Spanger, Marlene; Dahl, Hanne Marlene; Petersson, Elin

    2016-01-01

    discursive policy analysis with feminist state and multi-level governance theories. Paying attention to the role of the state, we focus on the framing of policy problems that are important for care chains and on potential tensions between different framings within a state and across the different levels...

  5. Sensitivity of a Simulated Derecho Event to Model Initial Conditions

    Science.gov (United States)

    Wang, Wei

    2014-05-01

    Since 2003, the MMM division at NCAR has been experimenting cloud-permitting scale weather forecasting using Weather Research and Forecasting (WRF) model. Over the years, we've tested different model physics, and tried different initial and boundary conditions. Not surprisingly, we found that the model's forecasts are more sensitive to the initial conditions than model physics. In 2012 real-time experiment, WRF-DART (Data Assimilation Research Testbed) at 15 km was employed to produce initial conditions for twice-a-day forecast at 3 km. On June 29, this forecast system captured one of the most destructive derecho event on record. In this presentation, we will examine forecast sensitivity to different model initial conditions, and try to understand the important features that may contribute to the success of the forecast.

  6. Primary Care of Adult Women: Common Dermatologic Conditions.

    Science.gov (United States)

    Ruiz de Luzuriaga, Arlene M; Mhlaba, Julie; Roman, Carly

    2016-06-01

    Dermatologic disease often presents in the primary care setting. Therefore, it is important for the primary care provider to be familiar with the presentation, diagnosis, and treatment of common skin conditions. This article provides an overview of acne, rosacea, melasma, vitiligo, alopecia, nonmelanoma, and melanoma skin cancer, dermatitis, and lichen sclerosus. PMID:27212088

  7. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  8. Sensitivity to Initial Conditions and Nonextensivity in Biological Evolution

    OpenAIRE

    Tamarit, Francisco A.; Cannas, Sergio A.; Tsallis, Constantino

    1996-01-01

    We consider biological evolution as described within the Bak and Sneppen 1993 model. We exhibit, at the self-organized critical state, a power-law sensitivity to the initial conditions, calculate the associated exponent, and relate it to the recently introduced nonextensive thermostatistics. The scenario which here emerges without tuning strongly reminds that of the tuned onset of chaos in say logistic-like onedimensional maps. We also calculate the dynamical exponent z.

  9. Dopaminergic sensitization in pigeons: conditioning and other influences

    OpenAIRE

    Keller, Sabine

    2001-01-01

    Apomorphine, a direct agonist of the neurotransmitter dopamine, elicits oral stereotypies when administered in low dosage. Pigeons react with longlasting bursts of pecks. When repeatedly administered a dose of apomorphine, pigeons show a behavioural sensitization expressed as an increasing pecking response to the drug. This increase is found to be partly dependent on conditioning to the environmental context in which apomorphine takes effect. The results of various experiments which led to th...

  10. Conditional nonlinear optimal perturbation: Applications to stability, sensitivity, and predictability

    Institute of Scientific and Technical Information of China (English)

    DUAN WanSuo; MU Mu

    2009-01-01

    Conditional nonlinear optimal perturbation (CNOP) is a nonlinear generalization of linear singular vec-tor (LSV) and features the largest nonlinear evolution at prediction time for the initial perturbations in a given constraint. It was proposed initially for predicting the limitation of predictability of weather or climate. Then CNOP has been applied to the studies of the problems related to predictability for weather and climate. In this paper, we focus on reviewing the recent advances of CNOP's applications,which involves the ones of CNOP in problems of ENSO amplitude asymmetry, block onset, and the sensitivity analysis of ecosystem and ocean's circulations, etc. Especially, CNOP has been primarily used to construct the initial perturbation fields of ensemble forecasting, and to determine the sensitive area of target observation for precipitations. These works extend CNOP'a applications to investigating the nonlinear dynamical behaviors of atmospheric or oceanic systems, even a coupled system, and studying the problem of the transition between the equilibrium states. These contributions not only attack the particular physical problems, but also show the superiority of CNOP to LSV in revealing the effect of nonlinear physical processes. Consequently, CNOP represents the optimal precursors for a weather or climate event; in predictability studies, CNOP stands for the initial error that has the largest negative effect on prediction; and in sensitivity analysis, CNOP is the most unstable (sensitive) mode.In multi-equilibrium state regime, CNOP is the initial perturbation that induces the transition between equilibriums most probably. Furthermore, CNOP has been used to construct ensemble perturbation fields in ensemble forecast studies and to identify sensitive area of target observation. CNOP theory has become more and more substantial. It is expected that CNOP also serves to improve the predict-ability of the realistic predictions for weather and climate events

  11. Conditional nonlinear optimal perturbation: Applications to stability, sensitivity, and predictability

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Conditional nonlinear optimal perturbation (CNOP) is a nonlinear generalization of linear singular vector (LSV) and features the largest nonlinear evolution at prediction time for the initial perturbations in a given constraint. It was proposed initially for predicting the limitation of predictability of weather or climate. Then CNOP has been applied to the studies of the problems related to predictability for weather and climate. In this paper, we focus on reviewing the recent advances of CNOP’s applications, which involves the ones of CNOP in problems of ENSO amplitude asymmetry, block onset, and the sensitivity analysis of ecosystem and ocean’s circulations, etc. Especially, CNOP has been primarily used to construct the initial perturbation fields of ensemble forecasting, and to determine the sensitive area of target observation for precipitations. These works extend CNOP’s applications to investigating the nonlinear dynamical behaviors of atmospheric or oceanic systems, even a coupled system, and studying the problem of the transition between the equilibrium states. These contributions not only attack the particular physical problems, but also show the superiority of CNOP to LSV in revealing the effect of nonlinear physical processes. Consequently, CNOP represents the optimal precursors for a weather or climate event; in predictability studies, CNOP stands for the initial error that has the largest negative effect on prediction; and in sensitivity analysis, CNOP is the most unstable (sensitive) mode. In multi-equilibrium state regime, CNOP is the initial perturbation that induces the transition between equilibriums most probably. Furthermore, CNOP has been used to construct ensemble perturbation fields in ensemble forecast studies and to identify sensitive area of target observation. CNOP theory has become more and more substantial. It is expected that CNOP also serves to improve the predictability of the realistic predictions for weather and climate

  12. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  13. Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus

    Directory of Open Access Journals (Sweden)

    Sofie Johanna Maria van Hoof

    2016-04-01

    Full Text Available Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation. Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated. Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol. Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care.

  14. Living In A Country With A Strong Primary Care System Is Beneficial To People With Chronic Conditions.

    Science.gov (United States)

    Hansen, Johan; Groenewegen, Peter P; Boerma, Wienke G W; Kringos, Dionne S

    2015-09-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries of the European Union, focusing on people's self-rated health status and whether or not they had severe limitations or untreated conditions. We found that people with chronic conditions were more likely to be in good or very good health in countries that had a stronger primary care structure and better coordination of care. People with more than two chronic conditions benefited most: Their self-rated health was higher if they lived in countries with a stronger primary care structure, better continuity of care, and a more comprehensive package of primary care services. In general, while having access to a strong primary care system mattered for people with chronic conditions, the degree to which it mattered differed across specific subgroups (for example, people with primary care-sensitive conditions) and primary care dimensions. Primary care reforms, therefore, should be person centered, addressing the needs of subgroups of patients while also finding a balance between structure and service delivery.

  15. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )

    2016-01-01

    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-s

  16. Nurse-sensitive health care outcomes in acute care settings: an integrative analysis of the literature.

    Science.gov (United States)

    Pierce, S F

    1997-04-01

    With the advent of profit maximization in health care came an increased focus on defining quality through outcomes achieved. The article describes an analysis of the nursing literature from 1974 to 1996 using Donabedian's structure-process-outcome framework and the specific indicators identified by the American Nurses Association report card, the Institute of Medicine, and the nursing-sensitive outcomes classification. Although evidence exists documenting nursing's positive impact on patient outcomes, this analysis suggests a real need to integrate our clinical and administrative studies and to employ a more comprehensive, longitudinal, multifacility approach if we are to answer the scientific question regarding which nursing structures and processes truly produce the best health outcomes. PMID:9097521

  17. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions Aspectos conceituais e metodológicos no estudo das hospitalizações por condições sensíveis à atenção primária

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2011-01-01

    Full Text Available Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a

  18. Culture and religion in nursing: providing culturally sensitive care.

    Science.gov (United States)

    Mendes, Aysha

    Last month, Aysha Mendes discussed the impact on care of personal beliefs held by both nurses and patients. This month, she delves into the aspects of culture and religion, which form important pieces of this puzzle, as well as the importance of culturally appropriate care provision in nursing practice.

  19. COMPUTATIONAL FLUID DYNAMICS BASED INVESTIGATION OF SENSITIVITY OF FURNACE OPERATIONAL CONDITIONS TO BURNER FLOW CONTROLS

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Zumao Chen; Dave Wang; Paul Wolff

    2004-06-01

    This is the extended second Semiannual Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project is to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. Our approach is to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner flow controls. The Electric Power Research Institute (EPRI) is providing co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center are active participants in this project. This program contains multiple tasks and good progress is being made on all fronts.

  20. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn;

    2014-01-01

    aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...... conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient's individual preferences for eight quality criteria...... (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future...

  1. Noise sensitivity and reactions to noise and other environmental conditions

    NARCIS (Netherlands)

    Miedema, H.M.E.; Vos, H.

    2003-01-01

    This article integrates findings from the literature and new results regarding noise sensitivity. The new results are based on analyses of 28 combined datasets (N=23 038), and separate analyses of a large aircraft noise study (N=10939). Three topics regarding noise sensitivity are discussed, namely,

  2. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

    Science.gov (United States)

    Nomaguchi, Kei M; Demaris, Alfred

    2013-06-01

    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims. PMID:23772093

  3. Talking about sensitive topics during the advance care planning discussion: A peek into the black box

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;

    2015-01-01

    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decis...... discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized....

  4. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators.

    Science.gov (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi

    2012-08-01

    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing.

  5. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators.

    Science.gov (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi

    2012-08-01

    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing. PMID:23050573

  6. Sensitive Measures of Condition Change in EEG Data

    Energy Technology Data Exchange (ETDEWEB)

    Hively, L.M.; Gailey, P.C.; Protopopescu, V.

    1999-03-10

    We present a new, robust, model-independent technique for measuring condition change in nonlinear data. We define indicators of condition change by comparing distribution functions (DF) defined on the attractor for time windowed data sets via L{sub 1}-distance and {chi}{sup 2} statistics. The new measures are applied to EEG data with the objective of detecting the transition between non-seizure and epileptic brain activity in an accurate and timely manner. We find a clear superiority of the new metrics in comparison to traditional nonlinear measures as discriminators of condition change.

  7. Chronic Exercise Increases Sensitivity to the Conditioned Rewarding Effects of Cocaine

    OpenAIRE

    Smith, Mark A.; Gergans, Samantha R.; Iordanou, Jordan C.; Lyle, Megan A.

    2008-01-01

    The purpose of this study was to determine whether chronic exercise alters sensitivity to the conditioned rewarding effects of cocaine. Female rats were obtained at weaning and randomly assigned to either sedentary or exercise conditions. After 6 weeks under these conditions, the effects of cocaine were examined in the conditioned place preference procedure. Cocaine produced a dose-dependent conditioned place preference in both groups of rats. Exercising rats were more sensitive than sedentar...

  8. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    Science.gov (United States)

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  9. Co-ordination and management of chronic conditions in Europe : the role of primary care.

    NARCIS (Netherlands)

    Gress, S.; Baan, C.A.; Calnan, M.; Dedeu, T.; Groenewegen, P.P.; Howson, H.

    2009-01-01

    Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for

  10. Computational Fluid Dynamics Based Investigation of Sensitivity of Furnace Operational Conditions to Burner Flow Controls

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Kirsi St. Marie; Dave Wang

    2003-04-30

    This is the first Semiannual Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project is to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. Our approach is to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner flow controls. The Electric Power Research Institute (EPRI) is providing co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center are active participants in this project. This program contains multiple tasks and good progress is being made on all fronts. A project kickoff meeting was held in conjunction with NETL's 2002 Sensors and Control Program Portfolio Review and Roadmapping Workshop, in Pittsburgh, PA during October 15-16, 2002. Dr. Marc Cremer, REI, and Dr. Paul Wolff, EPRI I&C, both attended and met with the project COR, Susan Maley. Following the review of REI's database of wall-fired coal units, the project team selected a front wall fired 150 MW unit with a Riley Low NOx firing system including overfire air for evaluation. In addition, a test matrix outlining approximately 25 simulations involving variations in burner secondary air flows, and coal and primary air flows was constructed. During the reporting period, twenty-two simulations have been completed, summarized, and tabulated for sensitivity analysis. Based on these results, the team is developing a suitable approach for quantifying the sensitivity coefficients associated with the parametric tests. Some of the results of the CFD

  11. Relationship among eye condition sensitivities,photosensitivity and epileptic syndromes

    Institute of Scientific and Technical Information of China (English)

    YANG Zhi-xian; CAI Xiang; LIU Xiao-yan; QIN Jiong

    2008-01-01

    Background Electroencephalogram(EEG)activity in normal subjects and epileptic patients is often closely related to the eye's status such as eye opened(EO),eye closure(ECL)and eyes closed(EC).ECL is the period immediately after closing of the eyes and only Iasts for Jess than 3 seconds if the eyes remain closed.EC is the pened as long as the eyes are closed.Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity(ECLS)or EC sensitivity (ECS).ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients.This study aimed to investigate the relationships among ECLS,ECS.photosensitivity and epilepsy syndromes in children.Methods EEG records from child patients in the EEG Department of Peking University First Hospital dudng the period of May 2005 to Mav 2007 were examined for the presence of ECLS or ECS.Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS.ECS and photosensitivity.Results Based on ECLS and ECS on their EEGs,30 patients were divided into ECLS group (16 cases)and ECS group (14 cases).There were more boys than girls in the two groups.The mean age of initial detection of ECLS and ECS was 10 years.and the average onset age of seizures was 9 years.The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy,Panayiotopoulos syndrome,symptomatic occipital lobe epilepsy,juvenile myoclonic epilepsy,juvenile absence epilepsy,eyelid myoclonia with absences,epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures.Those in the ECS group were iuvenile myoclonic epilepsy,idiopathic photosensitive occipital Iobe epilepsy,Panayiotopoulos syndrome and Gastaut type-idiclpathic children occipital epilepsy.Photosensitivity was detected in 88%of Patients with ECLS and 29%of patients with ECS.Conclusions ECLS and ECS are

  12. 42 CFR 494.90 - Condition: Patient plan of care.

    Science.gov (United States)

    2010-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a... appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must...

  13. Computational Fluid Dynamics Based Investigation of Sensitivity of Furnace Operational Conditions to Burner Flow Controls

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Dave Wang; Connie Senior; Andrew Chiodo; Steven Hardy; Paul Wolff

    2005-07-01

    This is the Final Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project was to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. The focus of this project was to quantify the potential impacts of ''fine level'' controls rather than that of ''coarse level'' controls (i.e. combustion tuning). Although it is well accepted that combustion tuning will generally improve efficiency and emissions of an ''out of tune'' boiler, it is not as well understood what benefits can be derived through active multiburner measurement and control systems in boiler that has coarse level controls. The approach used here was to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner air and fuel flow rates. The Electric Power Research Institute (EPRI) provided co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center have been active participants in this project. CFD simulations were completed for five coal fired boilers as planned: (1) 150 MW wall fired, (2) 500 MW opposed wall fired, (3) 600 MW T-Fired, (4) 330 MW cyclone-fired, and (5) 200 MW T-Fired Twin Furnace. In all cases, the unit selections were made in order to represent units that were descriptive of the utility industry as a whole. For each unit, between 25 and 44 furnace simulations were completed in order to evaluate impacts of burner to burner variations in: (1) coal and primary air flow rate, and (2) secondary air flow

  14. Neonatal Intensive Care and Child Psychiatry Inpatient Care: Do Different Working Conditions Influence Stress Levels?

    Directory of Open Access Journals (Sweden)

    Evalotte Mörelius

    2013-01-01

    Full Text Available Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout. Aim. To analyse possible differences in biological stress markers, psychosocial working conditions, health, and well-being between nurses working in two different departments. Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU (n=33 and nurses working in a child and adolescent psychiatry inpatient ward (CAP (n=14 using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person. Psychosocial working conditions, health, and well-being were measured once. Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient, poorer general health, and higher client-related burnout scores. Conclusion. When comparing these nurses with existing norm data for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses. Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health.

  15. Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS Programa Salud de la Familia y condiciones sensibles a la atención primaria, Sur de Brasil Family Health Program and ambulatory care-sensitive conditions in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2008-12-01

    familia, ser usuaria del Programa Salud de la Familia, consulta médica en la emergencia en el mes anterior a la investigación y hospital de internación; b hombres: rango de edad, haber sufrido otra internación en el año anterior a la entrevista y el hospital de internación. CONCLUSIONES: Las condiciones sensibles a la atención primaria permiten identificar grupos carentes de atención a la salud adecuada. A pesar de que el estudio no permita hacer inferencias sobre el riesgo de internación, los análisis por sexo y modelo de atención sugieren que el programa Salud de la Familia es más equitativo que la atención básica tradicional.OBJECTIVE: Ambulatory care-sensitive conditions (ACSC are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System. METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an

  16. The Sensitivity of the Geriatric Oral Health Assessment Index to Dental Care.

    Science.gov (United States)

    Dolan, Teresa A.

    1997-01-01

    A 24-month study of 96 patients in a community-based oral health promotion project found the Geriatric Oral Health Assessment Index (GOHAI), a self-report measure of oral health, to be sensitive to provision of dental care. Some further development of measures is needed. Potential applications of this and similar self-report measures in dental…

  17. Phase matching condition for enhancement of phase sensitivity in quantum metrology

    OpenAIRE

    Jing LIU; Jing, Xiaoxing; Wang, Xiaoguang

    2013-01-01

    We find a phase matching condition for enhancement of sensitivity in a Mach-Zehnder interferometer illuminated by an arbitrary state in one input port and an odd(even) state in the other port. Under this condition, the Fisher information becomes maximal with respect to the relative phase of two modes and the phase sensitivity is enhanced. For the case with photon losses, we further find that the phase matching condition keeps unchanged with a coherent state and a coherent superposition state ...

  18. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

    OpenAIRE

    Leppin, Aaron L; Victor M Montori; Gionfriddo, Michael R

    2015-01-01

    An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care...

  19. Conditions of Caregiving, Provider Nurturance, and Quality Care

    OpenAIRE

    Austin, Ann Marie Berghout; Lindauer, Shelley L. Knudsen; Rodriquez, Ariel; Nortion, Maria L.; Nelson, Farol A. Groutage

    1997-01-01

    Participants included 36 licensed family day care providers from six rural counties who had been providing care for a mean of 8.3 years (SO = 6.8 years). Fourteen of the providers had earned high school diplomas; twenty‐two had some post high school education. At least one child from an economically strained home (as measured by AFDC receipt) was present in 44.4% of the FDC homes. Dependent measures included: The Caregiver Interaction Scale (Arnett, 1989); Elaboration Scale from The Family Da...

  20. Associations of multiplicity of comorbid health conditions, serious mental illness, and health care costs.

    Science.gov (United States)

    Lee, Sungkyu; Black, Denise; Held, Mary

    2016-08-01

    Using a nationally representative U.S. sample, this study analyzed the effects of serious mental illness (SMI) and comorbid medical conditions on the cost of health care. The results of path model indicated that SMI and comorbid health conditions each increased total health care costs. Additionally, individuals with SMI were likely to have more comorbid medical conditions, which in turn, increased total health care costs. Findings raise awareness of an increased risk of medical conditions among individuals with SMI and the concern of high expenditures associated with comorbid SMI and medical conditions. PMID:27285200

  1. Basic Conditioning Factors' Influences on Adolescents' Healthy Behaviors, Self-Efficacy, and Self-Care

    OpenAIRE

    Callaghan, Donna

    2006-01-01

    This article reports a secondary statistical analysis of data from a study investigating the relationships among health-promoting self-care behaviors, self-care self-efficacy, and self-care agency in an adolescent population (Callaghan, 2005). The purpose of this study was to identify the influences of selected basic conditioning factors on the practice of healthy behaviors, self-efficacy beliefs, and ability for self-care in 256 adolescents. The research instruments used to collect data for ...

  2. Generalizing the Sensitivity Conditions in an Overall Index of Product Quality.

    OpenAIRE

    Praveen K. Kopalle; Donna L. Hoffman

    1992-01-01

    The issue of the sensitivity of weighted linear composites to attribute-importance weights has attracted researchers from various disciplines, including marketing, psychology, and statistics. At issue is how sensitive a weighted scale is to a particular choice of weights. Scale sensitivity is defined by a negative correlation between two scales. By considering the general case of "n" attributes and using an algebraic approach, the authors specify the precise sufficiency conditions under which...

  3. Practical strategies for providing culturally sensitive, ethical care in developing nations.

    Science.gov (United States)

    Crigger, Nancy J; Holcomb, Lygia

    2007-01-01

    Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

  4. Sensitization to apomorphine in pigeons : unaffected by latent inhibition but still due to classical conditioning

    OpenAIRE

    Wynne, Brigitte; Delius, Juan

    1995-01-01

    When administered apomorphine, pigeons exhibit protracted bouts of pecking behavior. This response is subject to sensitization, as it initially increases with repeated drug injections. The hypothesis is examined that the sensitization is due to a Pavlovian conditioning of the drug-induced pecking to the environment in which it first takes effect. In a first experiment, we attempted to suppress this conditioning by extensively pre-exposing the birds to the test environment and saline injection...

  5. Challenges to culturally sensitive care for elderly chinese patients: a first-generation Chinese-American perspective.

    Science.gov (United States)

    Chan, Karen C

    2013-01-01

    Physicians and medical institutions in the United States are placing increasing emphasis on providing culturally sensitive care for patients, such as implementing a Confucian family-based model of medical decision making when caring for elderly Chinese patients. In this article, I articulate various reasons why deferring to the family is not a guarantee of culturally sensitive care, particularly when family members are first-generation Chinese-Americans. Nonetheless, I offer several suggestions to help physicians, medical institutions, and family members to provide more culturally sensitive care for elderly Chinese patients. PMID:24597422

  6. Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity

    Directory of Open Access Journals (Sweden)

    Carolyn M. Tucker

    2016-02-01

    Full Text Available Background: Patient-centered culturally sensitive health care (PC-CSHC is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients’ report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF. This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. Methods: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. Results and Level of Evidence: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach’s αs= .916 and .912. Conclusion and Implications: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.

  7. BACTERIAL SPECTRUM AND PATTERN OF ANTIMICROBIAL SENSITIVITY AMONG OUTPATIENTS WITH PNEUMONIA IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sushma

    2015-04-01

    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  8. [Parental Care and Testosterone Secretion in Forest Rodent Males: Sensitization and Androgenic Stimulation of Parental Behavior].

    Science.gov (United States)

    Gromov, V S; Osadchuk, L V

    2015-01-01

    The reaction of males of three forest rodent species (Myodes clethrionomys, M. rutilus, Apodemus uralensis) to young animals in comparison with their dimensional characteristics and androgenization level was studied. Demonstration of parental care was detected in males of two vole species (M. clethrionomys and M. rutilus) in case of regular contacts with them (sensitization effect). It was demonstrated that the testosterone concentration in the blood serum, as well as the testosterone content in the testicles of the M. clethrionomys males (demonstrating the parental care), was higher than in the sample of males inclined to infanticide. An increased testosterone content in the testicles and blood serum was also found in the M. rutilus males that had contact with young animas. Neither demonstration of parental care nor significant differences in the testosterone concentration in the testicles and blood serum were detected in the A. uralensis males. PMID:26415283

  9. The Burnout Condition of Primary Health Care Personnel

    Directory of Open Access Journals (Sweden)

    Mehmet Kaya

    2007-10-01

    Full Text Available The concept of burnout was first introduced by Fredeunberger in 1974. Fredeunberger had stated that burnout occurred more commonly in occupations whose members directly work with people. The aim of the study is to examine the burnout status of primary health care staff. The universe of this descriptive study is 466 health staff who work in primary health care units in Kecioren. The participation of the study was 54%. A Questionnaire including Maslach Burnout Inventory (MBI and some characteristics of the participants were used for data collection. Mann-whitney U and Kruskal Wallis tests have been used for analizing the survey data. Seventyseven percent of the participants were female and the emotional exhaustion score of female was higher than male (p<0.01. The age of the participants effect the individual achievement scores (p<0.01. The profession or marital status of the participants didn’t affect the MBI scores. Some socio-demografic characteristics of the participants such as gender and age, affect the scores of MBI. Comprehensive studies which display the causes of problems, needed in this issue. [TAF Prev Med Bull. 2007; 6(5: 357-363

  10. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

    Directory of Open Access Journals (Sweden)

    Peter Angerer

    2015-05-01

    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  11. [Home care in a culturally sensitive environment: perspectives of caregivers of Haitian elderly patients and relatives].

    Science.gov (United States)

    Ducharme, Francine; Paquet, Mario; Vissandjée, Bilkis; Carpentier, Normand; Lévesque, Louise; Trudeau, Denise

    2008-01-01

    In Canada, the care provided by families occurs in an increasingly multiethnic context. Against this backdrop, the present qualitative study aims to explore the needs/expectations and solutions not only of (female) natural caregivers of an elderly relative hailing from Haiti (presented in terms of tracking cases) but also of remunerated home care providers - all with a view to developing a culturally sensitive service offering. As such, this study works from a conceptual framework centring on the negotiation of a common area of agreement between the stakeholders involved (i.e., natural caregivers and home care providers). To this end, focus groups and individual interviews were conducted among 15 caregivers and 37 home care providers. The three recurrent themes emerging from the data analysis concern, in context, the needs/expectations and solutions surrounding the experience of service use, barriers to use, and the relationships between natural caregivers and home care providers. The statements of both groups evidenced a consistency of views and have thus provided a basis for developing some recommendations acceptable to all stakeholders from the perspective of making culturally-based adjustments to the service offering.

  12. The Sensitiveness and Fulfillment of Psychological Needs: Medical, Health Care and Students.

    Science.gov (United States)

    Rakovec-Felser, Zlatka

    2015-09-01

    As health was defined as a state of complete physical, mental, and social well-being, and not merely an absence of disease or infirmity, the bio-psychosocial paradigm of health and illness attests that curing occurs when the science of medicine (the biomedical and pathos-physiological aspects of disease) and the art of medicine (the psychological, social, and interpersonal aspects of illness) merge into one unified holistic approach to patient care (Hojat, 2007). In this context the relationship between health care professionals and patients also become an indispensable tool in clinical situations to achieve better patient outcomes (Engel, 1990). In our pilot study in year 2009 we try to verify how are the medical students and students of health care (University of Maribor, Faculty of Medicine and Faculty of Health Care) prepared for their sensitive professional relationship in their future. Testing together 211 students (N=157 women, N=57 men), we compared the level of emotional empathy, altruistic love, values, and behaviorof 40 medical students, 118 students of health care and the group of 53 students of economics. Because of their professional choice, we expected that the medical and health care students would have higher empathy and altruism scores than the students of economics. Following the self-determination behavioral theory and its concept of autonomy support (Deci, Ryan, 2000), we anticipated also that the fulfilment of basic psychological needs could be important factor in everyday health care clinical practice. As the fulfilment of needs of autonomy, competence and relatedness could lead to increased autonomy supportive orientation in interactions with other subjects, and can be useful factor that prepare doctors or nurses for active participation in relationship with patients, we verified and compared the included groups also in this way. PMID:26898048

  13. What is conditional event algebra and why should you care?

    Science.gov (United States)

    Goodman, I. R.; Mahler, Ronald P. S.; Nguyen, H. T.

    1999-07-01

    Building practical intelligent-system algorithms requires appropriate tools for capturing the basic features of highly complex real-world environments. One of the most important of these tools, probability theory, is a calculus of events (e.g. EVENT = 'A fire-control radar of type A is detected' with Prob(EVENT) = 0.80). Conditional Event Algebra (CEA) is a relatively new inference calculus which rigorously extends standard probability theory to include events which are contingent--e.g. rules such as `If fire-control radar A is detected, then weapon B will be launched'; or conditionals such as `observation Z given target state X.' CEA allows one to (1) probabilistically model a contingent event; (2) assign a probability Prob(COND_EVENT) equals 0.50 to it; and (3) compute with such conditional events and probabilities using the same basic rules that govern ordinary events and probabilities. Since CEA is only about ten years old, it has achieved visibility primarily among specialists in expert-systems theory and mathematical logic. Recently, however, it has become clear that CEA has potentially radical implications for engineering practice as well. The purpose of this paper is to bring this promising new tool to the attention of the wider engineering community. We will give a tutorial introduction to CEA, based on simple motivational examples, and describe its potential applications in a number of practical engineering problems.

  14. Using online health communities to deliver patient-centered care to people with chronic conditions

    NARCIS (Netherlands)

    Eijk, M. van der; Faber, M.J.; Aarts, J.W.M.; Kremer, J.A.M.; Munneke, M.; Bloem, B.R.

    2013-01-01

    BACKGROUND: Our health care system faces major threats as the number of people with multiple chronic conditions rises dramatically. OBJECTIVE: To study the use of Online Health Communities (OHCs) as a tool to facilitate high-quality and affordable health care for future generations. METHODS: OHCs ar

  15. Clusterin and chemotherapy sensitivity under normoxic and graded hypoxic conditions in colorectal cancer.

    LENUS (Irish Health Repository)

    Kevans, David

    2012-06-01

    In vitro studies have shown that clusterin modulates treatment sensitivity in a number of human cancers; however, the interaction between clusterin expression and hypoxia in controlling treatment response in CRC has not previously been examined. The aim of this study was to assess the effect of clusterin overexpression in CRC cells on sensitivity to 5-fluorouracil (5-FU), oxaliplatin and FOLFOX treatment under normoxic and graded hypoxic conditions.

  16. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety.

    Science.gov (United States)

    Ulrey, K L; Amason, P

    2001-01-01

    Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication. PMID:11771806

  17. QTL mapping of inbreeding-related cold sensitivity and conditional lethality in Drosophila melanogaster

    DEFF Research Database (Denmark)

    Vermeulen, Corneel J.; Bijlsma, R.; Loeschcke, Volker

    2008-01-01

    . Whenever the expression of deleterious alleles is conditional, this can result in extreme environmental sensitivity in certain inbred lineages. Analysis of conditional lethal effects can reveal some of the loci that are sensitive to inbreeding. We performed a QTL (quantitative trait locus) mapping study...... of inbreeding-related and conditionally expressed lethality in Drosophila melanogaster. The lethal effect was triggered by exposure to a cold shock. We used a North Carolina crossing Design 3 to establish the mapping population, as well as to estimate the average dominance ratio and heritability. We found two...... QTL on the major autosomes carrying recessive lethals that caused male mortality, one of which also affected female mortality. More detailed study of these loci will provide information on the mechanistic basis and environmental sensitivity of inbreeding depression....

  18. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. PMID:26694313

  19. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered.

  20. Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests.

    Directory of Open Access Journals (Sweden)

    Kristen L Hess

    Full Text Available New rapid point-of-care (POC tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California.Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA, rapid plasma reagin (RPR, HCV enzyme immunoassay (EIA, and HIV-1/2 EIA.A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7-100% and the specificity was 99.7-100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0-52.7% and specificity was 98.7-99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥ 1 ∶ 8.The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

  1. Health conditions of elderly in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Cenir Gonçalves Tier

    2014-10-01

    Full Text Available This study aimed to identify the health conditions and environmental factors that influence the activities of daily living of elderly people. Cross-sectional epidemiological research conducted with 167 elderly in a municipality of Rio Grande do Sul, Brazil, from May to July 2013, using a structured instrument. Data were grouped for statistical/descriptive treatment. Circulatory diseases were the most frequent. The commonly used drug was aspirin, and falls were prevalent in 65 elderly. There was a significant difference in eating in age group older than 80 years (p=0,002. Dressing had significance in the age group above 80 years old (p=0.010, but was not significant when associated architecture with age. It was concluded that knowledge of the socio-demographic and health characteristics of the elderly enables the implementation of specific actions by health professionals, besides helping managers to formulate health indicators.

  2. Primary Care Sensitive Hospitalization: users detect flaws on the access to services

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2014-12-01

    Full Text Available The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

  3. Is there a risk of sensitization and allergy to chlorhexidine in health care workers?

    DEFF Research Database (Denmark)

    Garvey, L H; Roed-Petersen, J; Husum, B

    2003-01-01

    BACKGROUND: In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure. METHODS: Two hundred...... and forty-eight doctors, nurses and auxiliary staff were invited to participate in the study. One hundred and four individuals took part in the full study including skin tests and a questionnaire and a further 74 individuals filled in the questionnaire giving a total of 178 questionnaires (72%). Patch tests...... to examine the risk of type I and type IV allergy to chlorhexidine in health care workers with daily exposure to chlorhexidine, we did not identify allergies to chlorhexidine in any of the 104 individuals tested or in the additional 74 individuals who completed the questionnaire. We conclude that an allergy...

  4. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

    Science.gov (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  5. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  6. Premiums for Long-Term Care Insurance Packages: Sensitivity with Respect to Biometric Assumptions

    Directory of Open Access Journals (Sweden)

    Ermanno Pitacco

    2016-02-01

    Full Text Available Long-term care insurance (LTCI covers are rather recent products, in the framework of health insurance. It follows that specific biometric data are scanty; pricing and reserving problems then arise because of difficulties in the choice of appropriate technical bases. Different benefit structures imply different sensitivity degrees with respect to changes in biometric assumptions. Hence, an accurate sensitivity analysis can help in designing LTCI products and, in particular, in comparing stand-alone products to combined products, i.e., packages including LTCI benefits and other lifetime-related benefits. Numerical examples show, in particular, that the stand-alone cover is much riskier than all of the LTCI combined products that we have considered. As a consequence, the LTCI stand-alone cover is a highly “absorbing” product as regards capital requirements for solvency purposes.

  7. Antibiotic Sensitivity Pattern of Blood Isolates of Acinetobacter Species in a Tertiary Care Hospital: A Retrospective Analysis

    OpenAIRE

    P. S. Shareek; Sureshkumar, D; Ramgopalakrishnan; Ramasubramanian, V.; K. A. Ghafur; M. A. Thirunarayanan

    2012-01-01

    Problem statement: Multi-drug resistant Acinetobacter bacterium is one of the major causes of sepsis in ICUs in tertiary care hospitals in India. In this report we describe the antibiotic sensitivity patterns of Acinetobacter species isolated from blood over a one year period at a tertiary care hospital. Approach: We retrospectively analyzed the sensitivity pattern of Acinetobacter species isolated from blood during the period 1/6/2010 to 31/5/2011. Isolation and identification were performed...

  8. Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers.

    Science.gov (United States)

    Tsiachristas, Apostolos; Hipple-Walters, Bethany; Lemmens, Karin M M; Nieboer, Anna P; Rutten-van Mölken, Maureen P M H

    2011-07-01

    Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system--the chain-DTC--is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs.

  9. Managing multimorbidity in primary care in patients with chronic respiratory conditions.

    Science.gov (United States)

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  10. Managing multimorbidity in primary care in patients with chronic respiratory conditions

    Science.gov (United States)

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  11. Individualized Health Care Plans: Supporting Children With Chronic Conditions in the Classroom

    Science.gov (United States)

    Hopkins, Amanda F.; Hughes, Mary-alayne

    2016-01-01

    Due to the major advances in technology and the sciences, advances in the medical treatment options for children with chronic conditions are being made at an astonishing rate. In the health care field, "children with chronic conditions" is a generic phrase that typically refers to children with physical, developmental, behavioral, or…

  12. Fear conditioning fragments REM sleep in stress-sensitive Wistar-Kyoto, but not Wistar, rats

    OpenAIRE

    DaSilva, Jamie K.; Lei, Yanlin; Madan, Vibha; Mann, Graziella L.; Richard J. Ross; Tejani-Butt, Shanaz; Morrison, Adrian R.

    2010-01-01

    Pavlovian conditioning is commonly used to investigate the mechanisms of fear learning. Because the Wistar-Kyoto (WKY) rat strain is particularly stress-sensitive, we investigated the effects of a psychological stressor on sleep in WKY compared to Wistar (WIS) rats. Male WKY and WIS rats were either fear-conditioned to tone cues or received electric foot shocks alone. In the fear-conditioning procedure, animals were exposed to 10 tones (800 Hz, 90 dB, 5 sec), each co-terminating with a foot s...

  13. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

    Science.gov (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

    2016-01-01

    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  14. Sensitization of psychomotor stimulation and conditioned reward in mice: differential modulation by contextual learning.

    Science.gov (United States)

    Mead, Andy N; Crombag, Hans S; Rocha, Beatriz A

    2004-02-01

    Incentive motivation theory ascribes a critical role to reward-associated stimuli in the generation and maintenance of goal-directed behavior. Repeated psychomotor stimulant treatment, in addition to producing sensitization to the psychomotor-activating effects, can enhance the incentive salience of reward-associated cues and increase their ability to influence behavior. In the present study, we sought to investigate this incentive sensitization effect further by developing a model of conditioned reinforcement (CR) in the mouse and investigating the effects of a sensitizing treatment regimen of amphetamine on CR. Furthermore, we assessed the role of contextual stimuli in amphetamine-induced potentiation of CR. We found that mice responded selectively on a lever resulting in the presentation of a cue previously associated with 30% condensed milk solution, indicating that the cue had attained rewarding properties. Prior treatment with amphetamine (4 x 0.5 mg/kg i.p.) resulted in psychomotor sensitization and enhanced subsequent responding for the CR. Furthermore, this enhancement of responding for the cue occurred independent of the drug-paired context, whereas the sensitized locomotor response was only observed when mice were tested in the same environment as that in which they had received previous amphetamine. These results demonstrate that the CR paradigm previously developed in the rat can be successfully adapted for use in the mouse, and suggest that behavioral sensitization to amphetamine increases the rewarding properties (incentive salience) of reward-paired cues, independent of the drug-paired context.

  15. Occupational care giving conditions and human rights: A study of elderly caregivers in Botswana

    Directory of Open Access Journals (Sweden)

    Simon Kangethe

    2010-01-01

    Full Text Available The article aims to explore and discuss the occupational care giving conditions pitting them against human rights. The article′s objective is to initiate discussions and generate literature pertaining to occupational care giving load and assessing the human rights challenge it poses. The article uses analysis of the literature review from an array of eclectic data sources. The following factors were found besetting the caregivers′ human rights: (1 Aging; (2 Cultural and community attitudes towards care giving; (3 Risk of contagion; (4 Health hazards and lack of compensation. Recommendations: (1 Adoption of grandparents/grandchildren care symbiosis system; (2 Government remuneration policy for caregivers; (3 Mainstreaming of gender education to encourage men and youth develop an interest in care giving; (4 Institution of laws and policies by countries to provide for the compensation of caregivers′ occupational hazards and risks.

  16. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    OpenAIRE

    DuGoff, Eva H.; Bandeen-Roche, Karen; Anderson, Gerard F.

    2016-01-01

    Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. M...

  17. Experience of primary care among homeless individuals with mental health conditions.

    Directory of Open Access Journals (Sweden)

    Joya G Chrystal

    Full Text Available The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA, one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366 were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005, with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score. Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

  18. Comparison of winter wheat yield sensitivity to climate variables under irrigated and rain-fed conditions

    Science.gov (United States)

    Xiao, Dengpan; Shen, Yanjun; Zhang, He; Moiwo, Juana P.; Qi, Yongqing; Wang, Rende; Pei, Hongwei; Zhang, Yucui; Shen, Huitao

    2016-09-01

    Crop simulation models provide alternative, less time-consuming, and cost-effective means of determining the sensitivity of crop yield to climate change. In this study, two dynamic mechanistic models, CERES (Crop Environment Resource Synthesis) and APSIM (Agricultural Production Systems Simulator), were used to simulate the yield of wheat ( Triticum aestivum L.) under well irrigated (CFG) and rain-fed (YY) conditions in relation to different climate variables in the North China Plain (NCP). The study tested winter wheat yield sensitivity to different levels of temperature, radiation, precipitation, and atmospheric carbon dioxide (CO2) concentration under CFG and YY conditions at Luancheng Agro-ecosystem Experimental Stations in the NCP. The results from the CERES and APSIM wheat crop models were largely consistent and suggested that changes in climate variables influenced wheat grain yield in the NCP. There was also significant variation in the sensitivity of winter wheat yield to climate variables under different water (CFG and YY) conditions. While a temperature increase of 2°C was the threshold beyond which temperature negatively influenced wheat yield under CFG, a temperature rise exceeding 1°C decreased winter wheat grain yield under YY. A decrease in solar radiation decreased wheat grain yield under both CFG and YY conditions. Although the sensitivity of winter wheat yield to precipitation was small under the CFG, yield decreased significantly with decreasing precipitation under the rainfed YY treatment. The results also suggest that wheat yield under CFG linearly increased by ≈3.5% per 60 ppm (parts per million) increase in CO2 concentration from 380 to 560 ppm, and yield under YY increased linearly by ≈7.0% for the same increase in CO2 concentration.

  19. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum Radji; Siti Fauziah; Nurgani Aribinuko

    2011-01-01

    Objective: To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia. Methods: A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method. Results: Specimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively. Conclusions: Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  20. CFD Sensitivity Analysis of a Modern Civil Transport Near Buffet-Onset Conditions

    Science.gov (United States)

    Rumsey, Christopher L.; Allison, Dennis O.; Biedron, Robert T.; Buning, Pieter G.; Gainer, Thomas G.; Morrison, Joseph H.; Rivers, S. Melissa; Mysko, Stephen J.; Witkowski, David P.

    2001-01-01

    A computational fluid dynamics (CFD) sensitivity analysis is conducted for a modern civil transport at several conditions ranging from mostly attached flow to flow with substantial separation. Two different Navier-Stokes computer codes and four different turbulence models are utilized, and results are compared both to wind tunnel data at flight Reynolds number and flight data. In-depth CFD sensitivities to grid, code, spatial differencing method, aeroelastic shape, and turbulence model are described for conditions near buffet onset (a condition at which significant separation exists). In summary, given a grid of sufficient density for a given aeroelastic wing shape, the combined approximate error band in CFD at conditions near buffet onset due to code, spatial differencing method, and turbulence model is: 6% in lift, 7% in drag, and 16% in moment. The biggest two contributers to this uncertainty are turbulence model and code. Computed results agree well with wind tunnel surface pressure measurements both for an overspeed 'cruise' case as well as a case with small trailing edge separation. At and beyond buffet onset, computed results agree well over the inner half of the wing, but shock location is predicted too far aft at some of the outboard stations. Lift, drag, and moment curves are predicted in good agreement with experimental results from the wind tunnel.

  1. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  2. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Science.gov (United States)

    2010-10-01

    ... patients have the right to be free from physical or mental abuse, and corporal punishment. All patients..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation... U.S.C. 552(a) and 1 CFR part 51. A copy of the code is available for inspection at the...

  3. Sensitivity to initial conditions, entropy production, and escape rate at the onset of chaos

    Energy Technology Data Exchange (ETDEWEB)

    Fuentes, Miguel Angel, E-mail: fuentesm@santafe.edu [Centro Atomico Bariloche, Instituto Balseiro and CONICET, 8400 Bariloche (Argentina); Center for Advanced Studies in Ecology and Biodiversity, Facultad de Ciencias Biologicas, Pontificia Universidad Catolica de Chile, Casilla 114-D, Santiago CP 6513677 (Chile); Sato, Yuzuru [Kita 12 Nishi 6, Kita-ku, Sapporo, Hokkaido 060-0812 (Japan); Tsallis, Constantino, E-mail: tsallis@cbpf.br [Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 87501 (United States); Centro Brasileiro de Pesquisas Fisicas and National Institute of Science and Technology for Complex Systems, Rua Xavier Sigaud 150, 22290-180 Rio de Janeiro-RJ (Brazil)

    2011-08-01

    We analytically link three properties of nonlinear dynamical systems, namely sensitivity to initial conditions, entropy production, and escape rate, in z-logistic maps for both positive and zero Lyapunov exponents. We unify these relations at chaos, where the Lyapunov exponent is positive, and at its onset, where it vanishes. Our result unifies, in particular, two already known cases, namely (i) the standard entropy rate in the presence of escape, valid for exponential functionality rates with strong chaos, and (ii) the Pesin-like identity with no escape, valid for the power-law behavior present at points such as the Feigenbaum one. -- Highlights: → We study sensitivity, entropy production and escape rate. → We focus on one-dimensional simple nonlinear maps. → We discuss both strong and weak chaos. → Our results unify two cases that are already known in the literature. → The results are consistent with nonextensive statistics.

  4. Improving the care of people with long-term conditions in primary care: protocol for the ENHANCE pilot trial

    Directory of Open Access Journals (Sweden)

    Emma L. Healey

    2015-12-01

    Full Text Available Background: Long-term conditions (LTCs are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective: To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design: The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENHANCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion: Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418. Journal of Comorbidity 2015;5(1:135–149

  5. Operant conditioning of enhanced pain sensitivity by heat-pain titration.

    Science.gov (United States)

    Becker, Susanne; Kleinböhl, Dieter; Klossika, Iris; Hölzl, Rupert

    2008-11-15

    Operant conditioning mechanisms have been demonstrated to be important in the development of chronic pain. Most experimental studies have investigated the operant modulation of verbal pain reports with extrinsic reinforcement, such as verbal reinforcement. Whether this reflects actual changes in the subjective experience of the nociceptive stimulus remained unclear. This study replicates and extends our previous demonstration that enhanced pain sensitivity to prolonged heat-pain stimulation could be learned in healthy participants through intrinsic reinforcement (contingent changes in nociceptive input) independent of verbal pain reports. In addition, we examine whether different magnitudes of reinforcement differentially enhance pain sensitivity using an operant heat-pain titration paradigm. It is based on the previously developed non-verbal behavioral discrimination task for the assessment of sensitization, which uses discriminative down- or up-regulation of stimulus temperatures in response to changes in subjective intensity. In operant heat-pain titration, this discriminative behavior and not verbal pain report was contingently reinforced or punished by acute decreases or increases in heat-pain intensity. The magnitude of reinforcement was varied between three groups: low (N1=13), medium (N2=11) and high reinforcement (N3=12). Continuous reinforcement was applied to acquire and train the operant behavior, followed by partial reinforcement to analyze the underlying learning mechanisms. Results demonstrated that sensitization to prolonged heat-pain stimulation was enhanced by operant learning within 1h. The extent of sensitization was directly dependent on the received magnitude of reinforcement. Thus, operant learning mechanisms based on intrinsic reinforcement may provide an explanation for the gradual development of sustained hypersensitivity during pain that is becoming chronic. PMID:18774227

  6. Using operant conditioning and desensitization to facilitate veterinary care with captive reptiles.

    Science.gov (United States)

    Hellmuth, Heidi; Augustine, Lauren; Watkins, Barbara; Hope, Katharine

    2012-09-01

    In addition to being a large component of most zoological collections, reptile species are becoming more popular as family pets. Reptiles have the cognitive ability to be trained to facilitate daily husbandry and veterinary care. Desensitization and operant conditioning can alleviate some of the behavioral and physiological challenges of treating these species. A survey of reptile training programs at zoos in the United States and worldwide reveals that there are many successful training programs to facilitate veterinary care and minimize stress to the animal. Many of the techniques being used to train reptiles in zoological settings are transferable to the exotic pet clinician. PMID:22998960

  7. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum; Radji; Siti; Fauziah; Nurgani; Aribinuko

    2011-01-01

    Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  8. Role of cage material, working style and hearing sensitivity in perception of animal care noise.

    Science.gov (United States)

    Voipio, H-M; Nevalainen, T; Halonen, P; Hakumäki, M; Björk, E

    2006-10-01

    During daily care, laboratory animals are exposed to a variety of sounds which may have effects on welfare and also cause physiological and behavioural changes. So far, almost no attention has been paid to individual sounds or the sound level caused by animal care or the sound level inside the animal cage. In this study, sounds from selected rat care procedures were recorded: pulling cage out of the rack, placing it onto a table and replacing the cage back into the rack; with measurements made inside the rat cage and in the adjacent cage. Diet was poured into the food hopper and sounds were recorded inside the cage and also the adjacent cage. The work was repeated in a calm and also in a hurried style, using stainless steel and polycarbonate cages. Finally, the sounds produced by running tap water were recorded. Differences between rat and human hearing were compared using novel species-specific sound level weightings: R-weighting for rats dB(R) and H-weighting for human dB(H). Hurried work with steel caused sound exposure levels exceeding 90 dB(R) when the cages were placed into the rack and about 80 dB(R) when pulling them out of the rack or placing onto a table. With polycarbonate, the levels were 10-15 dB(R) lower. Unhurried calm working produced lower sound exposure levels than hurried working in many procedures. When the procedures were repeated with measurements in the adjacent cage, the sound exposure levels were lower, but the results were similar. Pouring food pellets into a hopper above the rat's head caused 15 dB(R) higher sound exposure levels than pouring food to an adjacent cage. In general, humans hear these sounds about 10-15 dB louder than rats. In conclusion, cage material, working style and hearing sensitivity all have an impact on the sound exposure level in the rodent cage. With correct working methods, high sound levels can be efficiently avoided in most cases. PMID:17018211

  9. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  10. A vegetation sensitivity approximation for gross primary production in water limited conditions.

    Science.gov (United States)

    Claesson, Jonas; Nycander, Jonas

    2013-04-01

    The most severe impact of climate change on vegetation growth and agriculture is likely to occur under water-limited conditions. Under such conditions the plants optimize the inward flux of CO2 and the outward flux of water vapor (the transpiration) by regulating the size of the stomata openings. Higher temperature increases water loss through transpiration, forcing the plants to diminish the stomata openings, which decreases photosynthesis. This is counteracted by higher CO2 concentration, which allows plants to maintain the inward flux of CO2 through the smaller openings. These two counteracting effects, combined with the change in precipitation, determine the net change of biological productivity in a changed climate. Here, a vegetation sensitivity approximation (VSA) is introduced, in order to understand and estimate the combined effect of changed temperature, CO2-concentration and precipitation on gross primary production (GPP) to first order. According to the VSA, we have: ( ) ?CO2atm ν GP P = ?0 P Here ?CO2atm is the atmospheric CO2 concentration, ?0 is the baseline for atmospheric CO2 concentration, P is precipitation and ν is defined by: -s- ν = 1 - 11°C where s is the climate sensitivity i.e. the increase in temperature when atmospheric CO2 is doubled. The VSA is based on the physical laws of gas flux through the stomata openings, and is only valid under water-limited conditions. It assumes that the temperature depends logarithmically on the CO2 concentration with a given climate sensitivity. Transpiration is assumed to be a constant fraction of precipitation, which is reasonable under water-limited conditions. The VSA is compared to simulations with the dynamic vegetation model LPJ. The agreement is reasonable, and the deviations can be understood by comparison with Köppen's definition of arid climate: in an arid climate growth increases more according to LPJ than according to the VSA, and in non-arid conditions the reverse is true. Both the VSA and

  11. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

    Science.gov (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter

    2004-12-01

    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  12. Mephedrone ('bath salt') elicits conditioned place preference and dopamine-sensitive motor activation.

    Science.gov (United States)

    Lisek, Renata; Xu, Wei; Yuvasheva, Ekaterina; Chiu, Yi-Ting; Reitz, Allen B; Liu-Chen, Lee-Yuan; Rawls, Scott M

    2012-11-01

    Abuse of a dangerous street drug called mephedrone (4-methylmethcathinone) has become commonplace in the United States. Mephedrone is hypothesized to possess abuse liability, share pharmacological properties with psychostimulants, and display toxicity that has been linked to fatalities and non-fatal overdoses. Knowledge about the pharmacology of mephedrone has been obtained primarily from surveys of drug abusers and emergency room visits rather than experimental studies. The present study used motor activity and conditioned place preference (CPP) assays to investigate behavioral effects of mephedrone. Acute mephedrone (3, 5, 10, 30 mg/kg, ip) administration increased ambulatory activity in rats. Mephedrone (5 mg/kg, ip)-induced ambulation was inhibited by pretreatment with a dopamine D1 receptor antagonist (SCH 23390) (0.5, 1, 2 mg/kg, ip) and enhanced by pretreatment with a dopamine D2 receptor antagonist (sulpiride) (2 mg/kg, ip). Rats injected for 5 days with low dose mephedrone (0.5 mg/kg, ip) and then challenged with mephedrone (0.5 mg/kg, ip) following 10 days of abstinence displayed sensitization of ambulatory activity. In CPP experiments, mephedrone (30 mg/kg, ip) conditioning elicited a preference shift in both rats and mice. The CPP and dopamine-sensitive motor activation produced by mephedrone is suggestive of abuse liability and indicates commonalities between the neuropharmacological profiles of mephedrone and established drugs of abuse.

  13. Practical guidance for nurses caring for stoma patients with long-term conditions.

    Science.gov (United States)

    Readding, Linda

    2016-02-01

    As the population ages and the number of people living with a long-term condition grows, it is likely that community nurses may be presented with increasing numbers of people requiring assessment, support, and advice for complex needs. Many of the long-term conditions affect the patient's ability to live and manage aspects of daily life independently and may affect the ability to manage a stoma. The purpose of this article is to consider how long-term conditions affect daily living and stoma care, and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma (ostomates) and a long-term condition have also been included. It is hoped that by reading this article, the nurse will become more familiar with the difficulties with dexterity associated with long-term conditions experienced by ostomates, and how they can be assisted in managing and living as independently as possible. PMID:26844603

  14. Temperament, disordered attachment and parental sensitivity in foster care: Differential findings on attachment security for shy children

    NARCIS (Netherlands)

    Schipper, de J.C.; Oosterman, M.; Schuengel, C.

    2012-01-01

    In a foster care sample, we tested the moderating effect of temperamental shyness on the association between parental sensitivity and attachment quality. The foster parents of 59 foster children (age M = 57 months, SD = 16.4) filled out the Child Behavior Questionnaire. To control for confounds, sym

  15. Applications of Conditional Nonlinear Optimal Perturbation in Predictability Study and Sensitivity Analysis of Weather and Climate

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Considering the limitation of the linear theory of singular vector (SV), the authors and their collaborators proposed conditional nonlinear optimal perturbation (CNOP) and then applied it in the predictability study and the sensitivity analysis of weather and climate system. To celebrate the 20th anniversary of Chinese National Committee for World Climate Research Programme (WCRP), this paper is devoted to reviewing the main results of these studies. First, CNOP represents the initial perturbation that has largest nonlinear evolution at prediction time, which is different from linear singular vector (LSV) for the large magnitude of initial perturbation or/and the long optimization time interval. Second, CNOP,rather than linear singular vector (LSV), represents the initial anomaly that evolves into ENSO events most probably. It is also the CNOP that induces the most prominent seasonal variation of error growth for ENSO predictability; furthermore, CNOP was applied to investigate the decadal variability of ENSO asymmetry. It is demonstrated that the changing nonlinearity causes the change of ENSO asymmetry.Third, in the studies of the sensitivity and stability of ocean's thermohaline circulation (THC), the non-linear asymmetric response of THC to finite amplitude of initial perturbations was revealed by CNOP.Through this approach the passive mechanism of decadal variation of THC was demonstrated; Also the authors studies the instability and sensitivity analysis of grassland ecosystem by using CNOP and show the mechanism of the transitions between the grassland and desert states. Finally, a detailed discussion on the results obtained by CNOP suggests the applicability of CNOP in predictability studies and sensitivity analysis.

  16. Paternal care decreases foraging activity and body condition, but does not impose survival costs to caring males in a Neotropical arachnid.

    Directory of Open Access Journals (Sweden)

    Gustavo S Requena

    Full Text Available Exclusive paternal care is the rarest form of parental investment in nature and theory predicts that the maintenance of this behavior depends on the balance between costs and benefits to males. Our goal was to assess costs of paternal care in the harvestman Iporangaia pustulosa, for which the benefits of this behavior in terms of egg survival have already been demonstrated. We evaluated energetic costs and mortality risks associated to paternal egg-guarding in the field. We quantified foraging activity of males and estimated how their body condition is influenced by the duration of the caring period. Additionally, we conducted a one-year capture-mark-recapture study and estimated apparent survival probabilities of caring and non-caring males to assess potential survival costs of paternal care. Our results indicate that caring males forage less frequently than non-caring individuals (males and females and that their body condition deteriorates over the course of the caring period. Thus, males willing to guard eggs may provide to females a fitness-enhancing gift of cost-free care of their offspring. Caring males, however, did not show lower survival probabilities when compared to both non-caring males and females. Reduction in mortality risks as a result of remaining stationary, combined with the benefits of improving egg survival, may have played an important and previously unsuspected role favoring the evolution of paternal care. Moreover, males exhibiting paternal care could also provide an honest signal of their quality as offspring defenders, and thus female preference for caring males could be responsible for maintaining the trait.

  17. Sensitivity to Speaker Control in the Online Comprehension of Conditional Tips and Promises: An Eye-Tracking Study

    Science.gov (United States)

    Stewart, Andrew J.; Haigh, Matthew; Ferguson, Heather J.

    2013-01-01

    Statements of the form if… then… can be used to communicate conditional speech acts such as tips and promises. Conditional promises require the speaker to have perceived control over the outcome event, whereas conditional tips do not. In an eye-tracking study, we examined whether readers are sensitive to information about perceived speaker control…

  18. Antibiotic Sensitivity Pattern of Blood Isolates of Acinetobacter Species in a Tertiary Care Hospital: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    P. S. Shareek

    2012-01-01

    Full Text Available Problem statement: Multi-drug resistant Acinetobacter bacterium is one of the major causes of sepsis in ICUs in tertiary care hospitals in India. In this report we describe the antibiotic sensitivity patterns of Acinetobacter species isolated from blood over a one year period at a tertiary care hospital. Approach: We retrospectively analyzed the sensitivity pattern of Acinetobacter species isolated from blood during the period 1/6/2010 to 31/5/2011. Isolation and identification were performed using the best alert system and VITEK2 respectively. Sensitivities were determined by Kirby Bauer disc diffusion and broth dilution using VITEK2 -AST cards. Results: The total number of Acinetobacter species isolated during the study period was 72, out of which 57 (79% were A. baumanii, 7 (9.7% were A. Iwofii and 3 (5.2% were A. Junii. One each from A. calcoaceticus, A. ursingii and A. denitrificans were isolated. All of the baumanii isolates were sensitive to polymyxin B and 61.4% were sensitive to tigecycline. Only 25% of the isolates in baumanii group were sensitive to meropenem and imipenem. In the non-baumanii group however, 73% were sensitive to carbapenems. Conclusion: There is a very high incidence of resistance to most antibiotics, including carbapenems. All of the Acinetobacter isolates tested are sensitive to polymyxin B. Tigecycline is the only other drug with reasonable susceptibilities, but this drug is not recommended for primary bacteriemias. If Acinetobacter sepsis is suspected, empiric therapy with polymyxins, followed by de-escalation after sensitivity results are back, is advisable.

  19. Anxiety sensitivity and its impact on pain experiences and conditions: a state of the art.

    Science.gov (United States)

    Stewart, Sherry H; Asmundson, Gordon J G

    2006-01-01

    This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets--basic laboratory-based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive-behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.

  20. Effect of solution treatment conditions on the sensitization of austenitic stainless steel

    Directory of Open Access Journals (Sweden)

    XIAOFEI YU

    2009-11-01

    Full Text Available In this study, the impact of the conditions of solution treatment on the degree of sensitization (DOS of austenitic stainless steel (AISI 304 was investigated in detail. The results derived from the electrochemical potentiodynamic reactivation (EPR test indicated that the DOS decreased as the solution treatment temperature and time increased. The reason for this was studied via the SEM morphologies and EDS results, which indicated that the grain size influenced the DOS. Furthermore, cellular automaton (CA was utilized to simulate grain growth, the precipitation of Cr-rich carbides and the three dimensional distribution of the chromium concentration, which vividly illuminated the effect of the grain size on the DOS and was in accordance with the experiment results.

  1. Clutter sensitivity test under controlled field conditions Resonant Microstrip Patch Antenna (RMPA) sensor technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-27

    Theoretical research, controlled laboratory tests, and these field test results show that nonmetallic (and metallic) shallowly buried objects can be detected and imaged with the Resonant Microstrip Patch Antenna (RMPA) sensor. The sensor can be modeled as a high Q cavity which capitalizes on its resonant condition sensitivity to scattered waves from buried objects. When the RMPA sensor is swept over a shallowly buried object, the RMPA fed-point impedance (resistance), measured with a Maxwell bridge, changes by tens of percent. The significant change in unprocessed impedance data can be presented in two-dimensional and three-dimensional graphical displays over the survey area. This forms silhouette images of the objects without the application of computationally intensive data processing algorithms. Because RMPA employed electromagnetic waves to illuminate the shallowly buried object, a number of questions and issues arise in the decision to fund or deny funding of the reconfiguration of the RMPA technology into a nonmetallic (metallic) land mine detector.

  2. A highly sensitive and simply operated protease sensor toward point-of-care testing.

    Science.gov (United States)

    Park, Seonhwa; Shin, Yu Mi; Seo, Jeongwook; Song, Ji-Joon; Yang, Haesik

    2016-04-21

    Protease sensors for point-of-care testing (POCT) require simple operation, a detection period of less than 20 minutes, and a detection limit of less than 1 ng mL(-1). However, it is difficult to meet these requirements with protease sensors that are based on proteolytic cleavage. This paper reports a highly reproducible protease sensor that allows the sensitive and simple electrochemical detection of the botulinum neurotoxin type E light chain (BoNT/E-LC), which is obtained using (i) low nonspecific adsorption, (ii) high signal-to-background ratio, and (iii) one-step solution treatment. The BoNT/E-LC detection is based on two-step proteolytic cleavage using BoNT/E-LC (endopeptidase) and l-leucine-aminopeptidase (LAP, exopeptidase). Indium-tin oxide (ITO) electrodes are modified partially with reduced graphene oxide (rGO) to increase their electrocatalytic activities. Avidin is then adsorbed on the electrodes to minimize the nonspecific adsorption of proteases. Low nonspecific adsorption allows a highly reproducible sensor response. Electrochemical-chemical (EC) redox cycling involving p-aminophenol (AP) and dithiothreitol (DTT) is performed to obtain a high signal-to-background ratio. After adding a C-terminally AP-labeled oligopeptide, DTT, and LAP simultaneously to a sample solution, no further treatment of the solution is necessary during detection. The detection limits of BoNT/E-LC in phosphate-buffered saline are 0.1 ng mL(-1) for an incubation period of 15 min and 5 fg mL(-1) for an incubation period of 4 h. The detection limit in commercial bottled water is 1 ng mL(-1) for an incubation period of 15 min. The developed sensor is selective to BoNT/E-LC among the four types of BoNTs tested. These results indicate that the protease sensor meets the requirements for POCT. PMID:26980003

  3. Brief encounters: what do primary care professionals contribute to peoples’ self-care support network for long-term conditions? A mixed methods study

    OpenAIRE

    Rogers, Anne; Vassilev, Ivaylo; Brooks, Helen; Kennedy, Anne; Blickem, Christian

    2016-01-01

    Background Primary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people’s personal communities of support for long-term condition management. Methods A mixed methods survey with nested qualitative study designed to identify relationships and socia...

  4. Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care.

    Science.gov (United States)

    Zvolensky, Michael J; Paulus, Daniel J; Bakhshaie, Jafar; Garza, Monica; Ochoa-Perez, Melissa; Medvedeva, Angela; Bogiaizian, Daniel; Robles, Zuzuky; Manning, Kara; Schmidt, Norman B

    2016-09-30

    From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample. PMID:27359301

  5. Modeling responses of Daphnia magna to pesticide pulse exposure under varying food conditions: intrinsic versus apparent sensitivity.

    NARCIS (Netherlands)

    Pieters, Barry J; Jager, Tjalling; Kraak, Michiel H S; Admiraal, Wim

    2006-01-01

    Recent studies showed that limiting food conditions resulted in either increased or decreased sensitivity of Daphnia magna to toxicants. It remained unclear whether these contrasting food-dependent alterations in toxicity resulted from differences in intrinsic sensitivity of the daphnids or from cha

  6. Sensitivity of Pliocene climate simulations in MRI-CGCM2.3 to respective boundary conditions

    Science.gov (United States)

    Kamae, Youichi; Yoshida, Kohei; Ueda, Hiroaki

    2016-08-01

    Accumulations of global proxy data are essential steps for improving reliability of climate model simulations for the Pliocene warming climate. In the Pliocene Model Intercomparison Project phase 2 (PlioMIP2), a part project of the Paleoclimate Modelling Intercomparison Project phase 4, boundary forcing data have been updated from the PlioMIP phase 1 due to recent advances in understanding of oceanic, terrestrial and cryospheric aspects of the Pliocene palaeoenvironment. In this study, sensitivities of Pliocene climate simulations to the newly archived boundary conditions are evaluated by a set of simulations using an atmosphere-ocean coupled general circulation model, MRI-CGCM2.3. The simulated Pliocene climate is warmer than pre-industrial conditions for 2.4 °C in global mean, corresponding to 0.6 °C warmer than the PlioMIP1 simulation by the identical climate model. Revised orography, lakes, and shrunk ice sheets compared with the PlioMIP1 lead to local and remote influences including snow and sea ice albedo feedback, and poleward heat transport due to the atmosphere and ocean that result in additional warming over middle and high latitudes. The amplified higher-latitude warming is supported qualitatively by the proxy evidences, but is still underestimated quantitatively. Physical processes responsible for the global and regional climate changes should be further addressed in future studies under systematic intermodel and data-model comparison frameworks.

  7. Hydrolysed ginseng-saponin quaternary: a novel conditioning agent for hair care products.

    Science.gov (United States)

    Young-Dae, K; Chang-Kew, K; Chung-Nam, L; Byung-Jo, H

    1989-10-01

    Synopsis A new quaternary ammonium compound, hydrolysed ginseng-saponin quaternary (HGSQ), from Korean ginseng saponin and 2,3-epoxypropyltrimethyl ammonium chloride, has been developed as a conditioning agent for hair care products. This structure has a hydrophobic group from the aglycone of ginseng saponin which is biologically active and considered as the most important component of Korean ginseng. Its properties of surface tension, conductivity, critical micelle concentration (CMC), eye irritation, sorption onto hair, tensile strength for 20% extension and moisture retention effect were studied. Its cationic character allows the molecule to be more substantive than ginseng saponin. HGSQ had good physical properties and was safe enough as a cosmetic raw material. Also half-head tests of HGSQ-containing shampoo were carried out to evaluate the conditioning effects in shampoos. HGSQ showed good conditioning properties in a shampoo.

  8. Association of Patient Care with Ventilator-Associated Conditions in Critically Ill Patients: Risk Factor Analysis.

    Directory of Open Access Journals (Sweden)

    Susumu Nakahashi

    Full Text Available Ventilator-associated conditions (VACs, for which new surveillance definitions and methods were issued by the Center for Disease Control and Prevention (CDC, are respiratory complications occurring in conjunction with the use of invasive mechanical ventilation and are related to adverse outcomes in critically ill patients. However, to date, risk factors for VACs have not been adequately established, leading to a need for developing a better understanding of the risks. The objective of this study was to explore care-related risk factors as a process indicator and provide valuable information pertaining to VAC preventive measures.This retrospective, single-center, cohort study was conducted in the intensive-care unit (ICU of a university hospital in Japan. Patient data were automatically sampled using a computerized medical records system and retrospectively analyzed. Management and care-related, but not host-related, factors were exhaustively analyzed using multivariate analysis for risks of VACs. VAC correlation to mortality was also investigated.Of the 3122 patients admitted in the ICU, 303 ventilated patients meeting CDC-specified eligibility criteria were included in the analysis. Thirty-seven VACs (12.2% were found with a corresponding rate of 12.1 per 1000 ventilator days. Multivariate analysis revealed four variables related to patient care as risk factors for VACs: absence of intensivist participation in management of ventilated patients [adjusted HR (AHR: 7.325, P < 0.001], using relatively higher driving pressure (AHR: 1.216, P < 0.001, development of edema (AHR: 2.145, P = 0.037, and a larger body weight increase (AHR: 0.058, P = 0.005. Furthermore, this research confirmed mortality differences in patients with VACs and statistically derived risks compared with those without VACs (HR: 2.623, P = 0.008.Four risk factors related to patient care were clearly identified to be the key factors for VAC preventive measures.

  9. Effect of environments, mechanical conditions, and sensitization on crack growth and AE behavior during corrosion fatigue processes of sensitized 304 stainless steel

    International Nuclear Information System (INIS)

    Corrosion fatigue tests were conducted for sensitized 304 austenitic stainless ste el to investigate effects of environments, mechanical conditions, and sensitization on crack growth and AE (Acoustic Emission) behavior. The crack growth rates of specimens were found to be accelerated in air as compared with those in the solution treated case. Those obtained in transpassive region and at corrosion potential were more accelerated, due to superposition of the acceleration by sensitization and environmental effects such as intergranular corrosion, metal dissolution, or hydrogen evolved from cathodic reaction. The AE activity during crack growth was much higher than that of so lution treated specimens through all the δK values in this study. This indicates that AE techniques are very useful to monitor crack growth processes under sensitized condition. SEM observations of the sensitized fracture surfaces revealed that many microcracks were nucleated at grain boundaries perpendicularly to the main crack surfaces at higher δK than --34 MPa.m sup(1/2). These microcracks (separations) were concluded to be the main AE source during the crack growth in air under sensitized condition, since the numbers of the separations were proportional to the detected AE event counts. In addition to separations, intergranular-like cracks were observed on the sensitized fracture surfaces tested in transpassive region. The high AE activity (event count rate) at relatively low δK level was ascribed to the nucleation of these intergranular-like cracks shich arose from intergranular corrosion and triaxial stress in the crack tip plastic zone. (J.P.N.)

  10. Texture-defined objects influence responses of blowfly motion-sensitive neurons under natural dynamical conditions

    Directory of Open Access Journals (Sweden)

    Thomas W. Ullrich

    2014-04-01

    Full Text Available The responses of visual interneurons of flies involved in the processing of motion information do not only depend on the velocity, but also on other stimulus parameters, such as the contrast and the spatial frequency content of the stimulus pattern. These dependencies have been known for long, but it is still an open question how they affect the neurons’ performance in extracting information about the structure of the environment under the specific dynamical conditions of natural flight. Free-flight of blowflies is characterized by sequences of phases of translational movements lasting for just 30-100 milliseconds interspersed with even shorter and extremely rapid saccade-like rotational shifts in flight and gaze direction. Previous studies already analyzed how nearby objects, leading to relative motion on the retina with respect to a more distant background, influenced the response of a class of fly motion sensitive visual interneurons, the HS cells. In the present study, we focused on objects that differed from their background by discontinuities either in their brightness contrast or in their spatial frequency content. We found strong object-induced effects on the membrane potential even during the short intersaccadic intervals, if the background contrast was small and the object contrast sufficiently high. The object evoked similar response increments provided that it contained higher spatial frequencies than the background, but not under reversed conditions. This asymmetry in the response behavior is partly a consequence of the depolarization level induced by the background. Thus, our results suggest that, under the specific dynamical conditions of natural flight, i.e. on a very short timescale, the responses of HS cells represent object information depending on the polarity of the difference between object and background contrast and spatial frequency content.

  11. Depression and risk of hospitalisations and rehospitalisations for ambulatory care-sensitive conditions in Denmark

    DEFF Research Database (Denmark)

    Davydow, Dimitry S; Fenger-Grøn, Morten; Ribe, Anette Riisgaard;

    2015-01-01

    , at risikoen for indlæggelse var 2,35 gange højere hos danskere med depression. Forskerne har set på de såkaldte preventable hospitalizations – altså indlæggelser, som måske kunne være undgået, hvis forebyggelse og behandling havde fungeret optimalt, herunder at patienten havde fulgt lægens anvisninger......Dette studie viser, at danskere med depression oftere end andre bliver hospitalsindlagt for kroniske sygdomme, som måske godt kunne være behandlet i det nære sundhedsvæsen uden indlæggelse. Den samme gruppe har også en højere risiko for at blive genindlagt inden for 30 dage. Resultaterne viser...

  12. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Summaiya Mulla

    2011-01-01

    Full Text Available Aims and Objectives: It has been observed that various microorganisms are acquiring resistance to most of the available potent antibiotics; hence, there is a need for every hospital to follow the use of antibiotics according to antibiotic sensitivity pattern in that particular hospital or geographical area. It has been reported that Enterobacteriaceae group of microorganisms are increasingly acquiring resistance to many antibiotics and this resistance varies geographically. As there is a short of recent data with respect to Indian hospital, this particular study was designed with the aim of establishing sensitivity pattern of Enterobacteriaceae group of microorganisms to various antibiotics. Materials and Methods: Data of antibiotic sensitivity from December 2010 to April 2011 of different Enterobacteriaceae was taken from the Department of Microbiology, Govt. Medical College, Surat. Sensitivity of different Enterobacteriaceae was shown as using descriptive statistics. Results: E. coli (55.6% and Klebsiella (31.2% were the most frequent bacteria isolated. Enterobacteriaceae were very less sensitive to amoxicillin + clavulanic acid (13.7%, chloramphenicol (7.6%, cefoperazone (14.4%, cefixime (15.7%, and cefuroxime (17.6. Sensitivity to aztreonam was 32.7%. Sensitivity to carbapenem group of drugs included in this study, i.e., meropenem was 69.8%. Highest sensitivity was shown for ceftazidime (74.1%. E. coli is more sensitive to meropenem as compared with Klebsiella. Conclusion: Sensitivity of Enterobacteriaceae group of microorganisms to known antibiotics is decreasing. Decreased sensitivity to carbapenem group of antibiotics is a matter of concern.

  13. How Does Sensitivity Training of Health Care Workers Impact Patient Satisfaction?

    Science.gov (United States)

    De Vinci, Katrina Marie

    2010-01-01

    Health care of the 21st century is undergoing major changes due to a myriad of social factors affecting every level of society. From financial desperation due to the high cost of health care to the increased awareness of a generation asking for better services, the importance of patient satisfaction is paramount. The Centers for Medicare and…

  14. Sensitivity of regional ensemble data assimilation spread to perturbations of lateral boundary conditions

    Directory of Open Access Journals (Sweden)

    Rachida El Ouaraini

    2015-12-01

    Full Text Available The implementation of a regional ensemble data assimilation and forecasting system requires the specification of appropriate perturbations of lateral boundary conditions (LBCs, in order to simulate associated errors. The sensitivity of analysis and 6-h forecast ensemble spread to these perturbations is studied here formally and experimentally by comparing three different LBC configurations for the ensemble data assimilation system of the ALADIN-France limited-area model (LAM. While perturbed initial LBCs are provided by the perturbed LAM analyses in each ensemble, the three ensemble configurations differ with respect to LBCs used at 3- and 6-h forecast ranges, which respectively correspond to: (1 perturbed LBCs provided by the operational global ensemble data assimilation system (GLBC, which is considered as a reference configuration; (2 unperturbed LBCs (ULBC obtained from the global deterministic model; (3 perturbed LBCs obtained by adding random draws of an error covariance model (PLBC to the global deterministic system. A formal analysis of error and perturbation equations is first carried out, in order to provide an insight of the relative effects of observation perturbations and of LBC perturbations at different ranges, in the various ensemble configurations. Horizontal variations of time-averaged ensemble spread are then examined for 6-h forecasts. Despite the use of perturbed initial LBCs, the regional ensemble ULBC is underdispersive not only near the lateral boundaries, but also in approximately one-third of the inner area, due to advection during the data assimilation cycle. This artefact is avoided in PLBC through the additional use of non-zero LBC perturbations at 3- and 6-h ranges, and the sensitivity to the amplitude scaling of the covariance model is illustrated for this configuration. Some aspects of the temporal variation of ensemble spread and associated sensitivities to LBC perturbations are also studied. These results

  15. Sensitivity of surveillance testing for multidrug-resistant Gram-negative bacteria in the intensive care unit.

    Science.gov (United States)

    Ridgway, Jessica P; Peterson, Lance R; Thomson, Richard B; Miller, Becky A; Wright, Marc-Oliver; Schora, Donna M; Robicsek, Ari

    2014-11-01

    We tested intensive care unit patients for colonization with multidrug-resistant Gram-negative bacilli (MDR GNB) and compared the results with those of concurrent clinical cultures. The sensitivity of the surveillance test for detecting MDR GNB was 58.8% (95% confidence interval, 48.6 to 68.5%). Among 133 patients with positive surveillance tests, 61% had no prior clinical culture with MDR GNB.

  16. Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices.

    Science.gov (United States)

    Bishop, Tara F; Ramsay, Patricia P; Casalino, Lawrence P; Bao, Yuhua; Pincus, Harold A; Shortell, Stephen M

    2016-03-01

    Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered. PMID:26953291

  17. Sensitivity of basal conditions in an inverse model: Vestfonna ice cap, Nordaustlandet/Svalbard

    Directory of Open Access Journals (Sweden)

    M. Schäfer

    2012-07-01

    Full Text Available The dynamics of Vestfonna ice cap (Svalbard are dominated by fast-flowing outlet glaciers. Its mass balance is poorly known and affected dynamically by these fast-flowing outlet glaciers. Hence, it is a challenging target for ice flow modeling. Precise knowledge of the basal conditions and implementation of a good sliding law are crucial for the modeling of this ice cap. Here we use the full-Stokes finite element code Elmer/Ice to model the 3-D flow over the whole ice cap. We use a Robin inverse method to infer the basal friction from the surface velocities observed in 1995. Our results illustrate the importance of the basal friction parameter in reproducing observed velocity fields. We also show the importance of having variable basal friction as given by the inverse method to reproduce the velocity fields of each outlet glacier – a simple parametrization of basal friction cannot give realistic velocities in a forward model. We study the robustness and sensitivity of this method with respect to different parameters (mesh characteristics, ice temperature, errors in topographic and velocity data. The uncertainty in the observational parameters and input data proved to be sufficiently small as not to adversely affect the fidelity of the model.

  18. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Science.gov (United States)

    2010-10-01

    ... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of...

  19. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    Science.gov (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  20. Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste.

    Science.gov (United States)

    Maamari, Olivia; Mouaffak, Lara; Kamel, Ramza; Brandam, Cedric; Lteif, Roger; Salameh, Dominique

    2016-03-01

    Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time-temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144°C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144°C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling.

  1. Decision analytic models, sensitivity analysis and value of information in economic evaluations in health care

    OpenAIRE

    Bischof, Matthias

    2010-01-01

    Economic evaluations of health care technologies are now commonly carried out to assess the economic value of new pharmaceuticals, medical devices and procedures. The aim of health economic evaluations is to measure, value and compare the costs and benefits of different health care interventions. To date, cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) are the two types of economic evaluations that are applied in the vast majority of economic evaluation studie...

  2. Redução das internações por condições sensíveis à atenção primária no Brasil entre 1998-2009 Reducción de las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998-2009 Reduction of ambulatory care sensitive conditions in Brazil between 1998 and 2009

    Directory of Open Access Journals (Sweden)

    Antonio Fernando Boing

    2012-04-01

    temporales con datos secundarios relacionados con las Internaciones Hospitalarias por condiciones susceptibles a atención primaria en el Sistema Único de Salud de Brasil. Los datos fueron obtenidos del Sistema de Informaciones Hospitalarias. Las tasas de internaciones por 10.000 habitantes fueron estandarizadas por grupo etario y sexo, considerando la población brasileña masculina recensada en 2000 como patrón. El análisis de tendencia de la serie histórica fue realizado por regresión linear generalizado por el método de Prais-Winsten. RESULTADOS: Hubo reducción en el promedio anual de internaciones por condiciones susceptibles a atención primaria de 3,7% entre hombres (IC95% -2,3;-5,1 y mujeres (IC95% -2,5;-5,6 entre 1998 y 2009. La tendencia varió en cada unidad federativa, sin embargo, en ninguna hubo aumento de las internaciones. En el sexo masculino y femenino las mayores reducciones fueron observadas en las internaciones por úlceras gastrointestinales (-11,7% al año y -12,1%, respectivamente, condiciones evitables (-8,8% y -8,9% y enfermedades de las vías aéreas inferiores (-8,0% y -8,1%. Angina (hombres, infección en el riñón y tracto urinario (hombres y mujeres y condiciones relacionados al prenatal y parto (mujeres presentaron aumento en las internaciones. Los tres grupos de enfermedades que más ocasionaron internaciones fueron gastroenteritis infecciosas y complicaciones, internaciones por insuficiencia cardíaca y asma. CONCLUSIONES: Hubo reducción sustancial en las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998 y 2009, sin embargo, algunas enfermedades presentaron estabilidad o aumento, exigiendo atención del sector salud.OBJECTIVE: To describe the trends in hospitalizations for ambulatory care sensitive conditions between 1998 and 2009 in Brazil. METHODS: The ecological time series study used secondary data on hospitalizations for ACSC in the Sistema Único de Saúde (SUS, National Unified Health System

  3. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    Science.gov (United States)

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  4. Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

    Science.gov (United States)

    Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

    2015-01-01

    Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

  5. Sensitivity analysis of helicopter IMC decelerating steep approach and landing performance to navigation system parameters. [Instrument Meteorological Conditions

    Science.gov (United States)

    Karmali, M. S.; Phatak, A. V.; Bull, J. S.; Peach, L. L.; Demko, P. S.

    1984-01-01

    The present investigation is concerned with a sensitivity analysis of the Decelerated Steep Approach and Landing (DSAL) maneuver to on-board and ground-based navigation system parameters. The Instrument Meteorological Conditions (IMC) DSAL maneuver involves decelerating to zero range rate while tracking the localizer and glideslope. The considered study investigated the performance of the navigation systems using Constant Deceleration Profile (CDP) guidance and a six degrees glideslope trajectory. A closed-loop computer simulation of the UH1H helicopter DSAL system was developed for the sensitivity analysis. Conclusions on system performance parameter sensitivity are discussed.

  6. Application of Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) to psychiatric practice in Japan: a preliminary assessment of validity and sensitivity to change.

    Science.gov (United States)

    Kimura, Taku; Yagi, Fukashi; Yoshizumi, Akira

    2013-08-01

    We applied an American medical necessity scale, Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS), to psychiatric practice in Japan. This is an exploratory analysis of empirical data of 272 patients. We examined the relationships between levels of care of LOCUS and clinical variables, contribution of care levels on admission decision, and changes in care levels over time. Inpatients showed significantly higher levels of care than outpatients. Levels of care showed significant strong inverse correlations to Global Assessment Scale (GAS) scores, and significant moderate correlations to admission types, care environment, and diagnostic subgroups in almost all groups. Levels of care contributed as much to the admission decision as GAS scores. Levels of care significantly decreased from the time of admission to discharge. Our preliminary evidence indicates that LOCUS is valid and sensitive to change, and applicable for clinical use in Japan.

  7. Absolute Depth Sensitivity in Cat Primary Visual Cortex under Natural Viewing Conditions.

    Science.gov (United States)

    Pigarev, Ivan N; Levichkina, Ekaterina V

    2016-01-01

    Mechanisms of 3D perception, investigated in many laboratories, have defined depth either relative to the fixation plane or to other objects in the visual scene. It is obvious that for efficient perception of the 3D world, additional mechanisms of depth constancy could operate in the visual system to provide information about absolute distance. Neurons with properties reflecting some features of depth constancy have been described in the parietal and extrastriate occipital cortical areas. It has also been shown that, for some neurons in the visual area V1, responses to stimuli of constant angular size differ at close and remote distances. The present study was designed to investigate whether, in natural free gaze viewing conditions, neurons tuned to absolute depths can be found in the primary visual cortex (area V1). Single-unit extracellular activity was recorded from the visual cortex of waking cats sitting on a trolley in front of a large screen. The trolley was slowly approaching the visual scene, which consisted of stationary sinusoidal gratings of optimal orientation rear-projected over the whole surface of the screen. Each neuron was tested with two gratings, with spatial frequency of one grating being twice as high as that of the other. Assuming that a cell is tuned to a spatial frequency, its maximum response to the grating with a spatial frequency twice as high should be shifted to a distance half way closer to the screen in order to attain the same size of retinal projection. For hypothetical neurons selective to absolute depth, location of the maximum response should remain at the same distance irrespective of the type of stimulus. It was found that about 20% of neurons in our experimental paradigm demonstrated sensitivity to particular distances independently of the spatial frequencies of the gratings. We interpret these findings as an indication of the use of absolute depth information in the primary visual cortex.

  8. Gas migration in KBS-3 buffer bentonite. Sensitivity of test parameters to experimental boundary conditions

    Energy Technology Data Exchange (ETDEWEB)

    Harrington, J.F.; Horseman, S.T. [British Geological Survey, Nottingham (United Kingdom)

    2003-01-01

    In the current Swedish repository design concept, hydrogen gas can be generated inside a waste canister by anaerobic corrosion of the ferrous metal liner. If the gas generation rate exceeds the diffusion rate of gas molecules in the buffer porewater, gas will accumulate in the void-space of a canister until its pressure becomes large enough for it to enter the bentonite as a discrete gaseous phase. Three long tenn gas injection tests have been performed on cylinders of pre-compacted MX80 bentonite. Two of these tests were undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. Gas was injected at a centrally located porous filter installed in the clay before hydration. Arrangements were made for gas to flow to three independently monitored sink-filter arrays mounted around the specimen. Axial and radial total stresses and internal porewater pressures were continuously monitored. Breakthrough and peak gas pressures were substantially larger than the sum of the swelling pressure and the external porewater. The third test was performed. using an apparatus which radially constrains the specimen during gas flow. Observed sensitivity of the breakthrough and peak gas pressures to the test boundary conditions suggests that gas entry must be accompanied by dilation of the bentonite fabric. In other words, there is a tendency for the volume of the specimen to increase during this process. The experimental evidence is consistent with the flow of gas along a relatively small number of crack-like pathways which propagate through the clay as gas pressure increases. Gas entry and breakthrough under constant volume boundary conditions causes a substantial increase in the total stress and the internal porewater pressure. It is possible to determine the point at which gas enters the clay by monitoring changes in these parameters. Localisation of gas flow within multiple pathways results, in nonuniform discharge rates at the sinks. When gas injection

  9. Gas migration in KBS-3 buffer bentonite. Sensitivity of test parameters to experimental boundary conditions

    International Nuclear Information System (INIS)

    In the current Swedish repository design concept, hydrogen gas can be generated inside a waste canister by anaerobic corrosion of the ferrous metal liner. If the gas generation rate exceeds the diffusion rate of gas molecules in the buffer porewater, gas will accumulate in the void-space of a canister until its pressure becomes large enough for it to enter the bentonite as a discrete gaseous phase. Three long tenn gas injection tests have been performed on cylinders of pre-compacted MX80 bentonite. Two of these tests were undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. Gas was injected at a centrally located porous filter installed in the clay before hydration. Arrangements were made for gas to flow to three independently monitored sink-filter arrays mounted around the specimen. Axial and radial total stresses and internal porewater pressures were continuously monitored. Breakthrough and peak gas pressures were substantially larger than the sum of the swelling pressure and the external porewater. The third test was performed. using an apparatus which radially constrains the specimen during gas flow. Observed sensitivity of the breakthrough and peak gas pressures to the test boundary conditions suggests that gas entry must be accompanied by dilation of the bentonite fabric. In other words, there is a tendency for the volume of the specimen to increase during this process. The experimental evidence is consistent with the flow of gas along a relatively small number of crack-like pathways which propagate through the clay as gas pressure increases. Gas entry and breakthrough under constant volume boundary conditions causes a substantial increase in the total stress and the internal porewater pressure. It is possible to determine the point at which gas enters the clay by monitoring changes in these parameters. Localisation of gas flow within multiple pathways results, in nonuniform discharge rates at the sinks. When gas injection

  10. Post-trial dopaminergic modulation of conditioned catalepsy: A single apomorphine induced increase/decrease in dopaminergic activation immediately following a conditioned catalepsy response can reverse/enhance a haloperidol conditioned and sensitized catalepsy response.

    Science.gov (United States)

    Oliveira, Lucas Rangel; Dias, Flávia Regina Cruz; Santos, Breno Garone; Silva, Jade Leal Loureiro; Carey, Robert J; Carrera, Marinete Pinheiro

    2016-09-15

    Haloperidol can induce catalepsy and this drug effect can be conditioned as well as sensitized to contextual cues. We used a paired/unpaired Pavlovian conditioning protocol to establish haloperidol catalepsy conditioned and sensitized responses. Groups of rats were given 10 daily catalepsy tests following administration of vehicle (n=24) or haloperidol (1.0mg/kg) either paired (n=18) or unpaired (n=18) to testing. Subsequently, testing for conditioning was conducted and conditioning and sensitization of catalepsy were observed selectively in the paired group. Immediately following a second test for catalepsy conditioning, the groups were subdivided into 4 vehicle groups, 3 unpaired haloperidol groups and 3 paired haloperidol groups and were given one of three post-trial treatments (vehicle, 0.05mg/kg or 2.0mg/kg apomorphine). One day later the conditioned catalepsy test 3 was carried out and on the next day, a haloperidol challenge test was performed. The post-trial apomorphine treatments had major effects on the paired groups upon both conditioning and the haloperidol challenge test. The low dose apomorphine post-trial treatment enhanced both the conditioned and the haloperidol sensitized catalepsy responses. The high dose apomorphine post-trial treatment eliminated conditioned catalepsy and eliminated the initial acute catalepsy response to haloperidol that was induced in the vehicle control groups. These results demonstrate the sensitivity of conditioned drug cues to modification by increases/decreases in activity of the dopamine system in the immediate post-trial interval after a conditioning trial. This demonstration that post-trial dopaminergic drug treatments can modify conditioned drug behavior has broad implications for conditioned drug effects.

  11. Post-trial dopaminergic modulation of conditioned catalepsy: A single apomorphine induced increase/decrease in dopaminergic activation immediately following a conditioned catalepsy response can reverse/enhance a haloperidol conditioned and sensitized catalepsy response.

    Science.gov (United States)

    Oliveira, Lucas Rangel; Dias, Flávia Regina Cruz; Santos, Breno Garone; Silva, Jade Leal Loureiro; Carey, Robert J; Carrera, Marinete Pinheiro

    2016-09-15

    Haloperidol can induce catalepsy and this drug effect can be conditioned as well as sensitized to contextual cues. We used a paired/unpaired Pavlovian conditioning protocol to establish haloperidol catalepsy conditioned and sensitized responses. Groups of rats were given 10 daily catalepsy tests following administration of vehicle (n=24) or haloperidol (1.0mg/kg) either paired (n=18) or unpaired (n=18) to testing. Subsequently, testing for conditioning was conducted and conditioning and sensitization of catalepsy were observed selectively in the paired group. Immediately following a second test for catalepsy conditioning, the groups were subdivided into 4 vehicle groups, 3 unpaired haloperidol groups and 3 paired haloperidol groups and were given one of three post-trial treatments (vehicle, 0.05mg/kg or 2.0mg/kg apomorphine). One day later the conditioned catalepsy test 3 was carried out and on the next day, a haloperidol challenge test was performed. The post-trial apomorphine treatments had major effects on the paired groups upon both conditioning and the haloperidol challenge test. The low dose apomorphine post-trial treatment enhanced both the conditioned and the haloperidol sensitized catalepsy responses. The high dose apomorphine post-trial treatment eliminated conditioned catalepsy and eliminated the initial acute catalepsy response to haloperidol that was induced in the vehicle control groups. These results demonstrate the sensitivity of conditioned drug cues to modification by increases/decreases in activity of the dopamine system in the immediate post-trial interval after a conditioning trial. This demonstration that post-trial dopaminergic drug treatments can modify conditioned drug behavior has broad implications for conditioned drug effects. PMID:27173428

  12. CULTURE AND SENSITIVITY OF BACTERIAL GROWTH FROM EXOTIC COWS SUFFERING FROM ENDOMETRITIS UNDER PAKISTANI CONDITIONS

    Directory of Open Access Journals (Sweden)

    Idrees Ali Zahid

    2004-04-01

    Full Text Available Bacteriology of endometritis and in vitro antibiotic sensitivity of the isolates in Holstein Friesian and Jersey cows maintained at Research Institute for Physiology of Animal Reproduction, Bhunikey, District Kasur were carried out. Out of 100 samples, 89 contained different strains of bacteria and 11 were found bacteriologically sterile. Different species of bacteria isolated from these samples were, Bacillus subtilis (08.99%, Corynebacterium pyogenes (19.10%, Escherichia coli (29.21%, Neisseria meningitides (03.37%, Staphylococcus aureus (23.60%, Streptococcus pneumonia (03.37% and Streptococcus pyogenes (12.36%. The in vitro antibiotic sensitivity test indicated that the highest number of isolates (92% were sensitive to neomycin, followed by doxycyline (89%. Clindramycin showed the lowest results in terms of in vitro antibiotic sensitivity (51%.

  13. Preferences for health care and self-management among Dutch adolescents with chronic conditions: a Q-methodological investigation

    NARCIS (Netherlands)

    Jedeloo, S.; Staa, A.L. van; Latour, J.M.; Exel, N.J. van

    2009-01-01

    Adolescents with chronic conditions have to learn to self-manage their health in preparation for transitioning to adult care. Nurses often struggle with how to approach youth with chronic conditions successfully. Little is known about the preferences and attitudes of these young people themselves.

  14. The Process of Interactional Sensitivity Coding in Health Care: Conceptually and Operationally Defining Patient-Centered Communication.

    Science.gov (United States)

    Sabee, Christina M; Koenig, Christopher J; Wingard, Leah; Foster, Jamie; Chivers, Nick; Olsher, David; Vandergriff, Ilona

    2015-01-01

    This study aimed to develop a process for measuring sensitivity in provider-patient interactions to better understand patient-centered communication. The authors developed the Process of Interactional Sensitivity Coding in Healthcare (PISCH) by incorporating a multimethod investigation into conversations between physicians and their patients with type 2 diabetes. The PISCH was then applied and assessed for its reliability across the unitization of interactions, the activities that were reflected, and the characteristics of patient-centered interactional sensitivity that were observed within each unit. In most cases, the PISCH resulted in reliable analysis of the interactions, but a few key areas (shared decision making, enabling self-management, and responding to emotion) were not reliably assessed. Implications of the test of this coding scheme include the expansion of the theoretical notion of interactional sensitivity to the health care context, rigorous implementation of a multimethod measurement development that relied on qualitative and quantitative assessments, and important future questions about the role of communication concepts in future interpersonal research.

  15. Computer aided diagnosis for mental health care : On the clinical validation of sensitive machines

    NARCIS (Netherlands)

    Sluis, F. van der; Dijkstra, T.; Broek, E.L. van den

    2012-01-01

    This study explores the feasibility of sensitive machines; that is, machines with empathic abilities, at least to some extent. A signal processing and machine learning pipeline is presented that is used to analyze data from two studies in which 25 Post-Traumatic Stress Disorder (PTSD) patients parti

  16. Rapid, high sensitivity, point-of-care test for cardiac troponin based on optomagnetic biosensor

    NARCIS (Netherlands)

    Dittmer, W.U.; Evers, T.H.; Hardeman, W.M.; Huijnen-Keur, W.M.; Kamps, R.; De Kievit, P.; Neijzen, J.H.M.; Sijbers, M.J.J.; Nieuwenhuis, J.H.; Hefti, M.H.; Dekkers, D.; Martens, M.

    2010-01-01

    BACKGROUND: We present a handheld integrated device based on a novel magnetic-optical technology for the sensitive detection of cardiactroponin I, a biomarker for the positive diagnosis of myocardial infarct, in a finger-prick blood sample. The test can be performed with a turn-around time of 5 min

  17. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. PMID:26953298

  18. Treated wastewater irrigation: uptake of pharmaceutical and personal care products by common vegetables under field conditions.

    Science.gov (United States)

    Wu, Xiaoqin; Conkle, Jeremy L; Ernst, Frederick; Gan, Jay

    2014-10-01

    Global water shortage is placing an unprecedented pressure on water supplies. Treated wastewater is a valuable water resource, but its reuse for agricultural irrigation faces a roadblock: the public concern over the potential accumulation of contaminants of emerging concern (CECs) into human diet. In the present study, we measured the levels of 19 commonly occurring pharmaceutical and personal care products (PPCPs) in 8 vegetables irrigated with treated wastewater under field conditions. Tertiary treated wastewater without or with a fortification of each PPCP at 250 ng/L, was used to irrigate crops until harvest. Plant samples at premature and mature stages were collected. Analysis of edible tissues showed a detection frequency of 64% and 91% in all vegetables from the treated wastewater and fortified water treatments, respectively. The edible samples from the two treatments contained the same PPCPs, including caffeine, meprobamate, primidone, DEET, carbamazepine, dilantin, naproxen, and triclosan. The total concentrations of PPCPs detected in edible tissues from the treated wastewater and fortified irrigation treatments were in the range of 0.01-3.87 and 0.15-7.3 ng/g (dry weight), respectively. Annual exposure of PPCPs from the consumption of mature vegetables irrigated with the fortified water was estimated to be only 3.69 μg per capita. Results from the present study showed that the accumulation of PPCPs in vegetables irrigated with treated wastewater was likely limited under field conditions. PMID:25211705

  19. Prenatal Choline Availability Alters the Context Sensitivity of Pavlovian Conditioning in Adult Rats

    Science.gov (United States)

    Lamoureux, Jeffrey A.; Meck, Warren H.; Williams, Christina L.

    2008-01-01

    The effects of prenatal choline availability on Pavlovian conditioning were assessed in adult male rats (3-4 mo). Neither supplementation nor deprivation of prenatal choline affected the acquisition and extinction of simple Pavlovian conditioned excitation, or the acquisition and retardation of conditioned inhibition. However, prenatal choline…

  20. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

    Directory of Open Access Journals (Sweden)

    Künzi Beat

    2010-11-01

    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  1. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Science.gov (United States)

    2010-10-01

    ..., care planning, and coordination of services. 418.56 Section 418.56 Public Health CENTERS FOR MEDICARE... interdisciplinary group to provide coordination of care and to ensure continuous assessment of each patient's and... care. (e) Standard: Coordination of services. The hospice must develop and maintain a system...

  2. Integrated community teams – promoting continuity of care for people with long-term neurological conditions (LTNCs)?

    OpenAIRE

    Aspinal, Fiona; Bernard, Sylvia; Gridley, Kate; Parker, Gillian

    2011-01-01

    Purpose The SDO funded study ‘Integrated services for people with long-term neurological conditions: evaluation of the impact of the National Service Framework’ aimed to identify what helps or hinders integrated services and identify models and practice for delivering continuity of care for people with LTNCs. Theory People’s experiences of integrated services were explored by thematically analysing the data using Freeman et al.’s [1, 2] definitions of continuity of care as a conceptual framew...

  3. Fast, sensitive point of care electrochemical molecular system for point mutation and select agent detection.

    Science.gov (United States)

    MacLeod, J A; Nemeth, A C; Dicke, W C; Wang, D; Manalili Wheeler, S; Hannis, J C; Collier, G B; Drader, J J

    2016-07-01

    Point of care molecular diagnostics benefits from a portable battery-operated device capable of performing a fast turnaround using reliable inexpensive cartridges. We describe a prototype device for performing a molecular diagnostics test for clinical and biodefense samples in 16 minutes using a prototype capable of an 8 minute PCR reaction, followed by hybridization and detection on an electrochemical microarray based on the i-STAT® system. We used human buccal swabs for hemochromatosis testing including in-device DNA extraction. Additional clinical and biodefense samples included influenza A and bacterial select agents Bacillus anthracis, Yersinia pestis and Francisella tularensis. PMID:27280174

  4. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    Directory of Open Access Journals (Sweden)

    Latour Judith

    2009-07-01

    Full Text Available Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs. Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT, were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%. Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT

  5. Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

    Directory of Open Access Journals (Sweden)

    John P Hirdes

    Full Text Available BACKGROUND: Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. METHODS: Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940, complex continuing care hospitals/units (n = 88,721, and nursing homes (n = 185,309 in seven Canadian provinces/territories. RESULTS: CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. CONCLUSIONS: CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

  6. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Yukari C Manabe

    Full Text Available BACKGROUND: Accurate, inexpensive point-of-care CD4+ T cell testing technologies are needed that can deliver CD4+ T cell results at lower level health centers or community outreach voluntary counseling and testing. We sought to evaluate a point-of-care CD4+ T cell counter, the Pima CD4 Test System, a portable, battery-operated bench-top instrument that is designed to use finger stick blood samples suitable for field use in conjunction with rapid HIV testing. METHODS: Duplicate measurements were performed on both capillary and venous samples using Pima CD4 analyzers, compared to the BD FACSCalibur (reference method. The mean bias was estimated by paired Student's t-test. Bland Altman plots were used to assess agreement. RESULTS: 206 participants were enrolled with a median CD4 count of 396 (range; 18-1500. The finger stick PIMA had a mean bias of -66.3 cells/µL (95%CI -83.4-49.2, P500 cells/µL with a mean bias of -120.6 (95%CI -162.8, -78.4, P<0.001. The sensitivity (95%CI of the Pima CD4 analyzer was 96.3% (79.1-99.8% for a <250 cells/ul cut-off with a negative predictive value of 99.2% (95.1-99.9%. CONCLUSIONS: The Pima CD4 finger stick test is an easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field. Issues of negatively-biased CD4 cell counts especially at higher absolute numbers will limit its utility for longitudinal immunologic response to ART. The high sensitivity and negative predictive value of the test makes it an attractive option for field use to identify patients eligible for ART, thus potentially reducing delays in linkage to care and ART initiation.

  7. Sensitivity analyses of biodiesel thermo-physical properties under diesel engine conditions

    DEFF Research Database (Denmark)

    Cheng, Xinwei; Ng, Hoon Kiat; Gan, Suyin;

    2016-01-01

    This reported work investigates the sensitivities of spray and soot developments to the change of thermo-physical properties for coconut and soybean methyl esters, using two-dimensional computational fluid dynamics fuel spray modelling. The choice of test fuels made was due to their contrasting s...

  8. Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions.

    Science.gov (United States)

    Robinson, Monica; Fisher, Thomas F; Broussard, Kim

    2016-01-01

    Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

  9. Assessment of the radiation sensitivity of patients after conditioning irradiation as preparation for bone marrow or stem cell transplantation

    International Nuclear Information System (INIS)

    The knowledge on the radiation sensitivity of individual patients would allow a better planning of conditioning irradiation including the possibility of dose increase that might enhance the chance of a successful bone marrow or stem cell transplantation. The study was focused on the search of reliable and fast laboratory test procedures to predict the individual radiation sensitivity. Several blood tests were evaluated with respect to their appropriateness: mostly flow-cytometric test on lymphocytes: micronuclei, cell proliferation, apoptosis activation of cytokines and the total number of leucocytes, blood stem cells CD4+ and CD8+ lymphocytes, and a spectro-photometric test of blood plasma for the determination of the antioxidative capacity

  10. Organic particulate material levels in the atmosphere: conditions favoring sensitivity to varying relative humidity and temperature.

    Science.gov (United States)

    Pankow, James F

    2010-04-13

    This study examines the sensitivity in predicted levels of atmospheric organic particulate matter (M(o), microg m(-3)) as those levels may potentially be affected by changes in relative humidity and temperature. In a given system, for each partitioning compound, f(g) and f(p) represent the gaseous and particulate fractions (f(g) + f(p) = 1). Sensitivity in the M(o) levels becomes dampened as the compounds contributing significantly to M(o) are increasingly found in the particle phase (f(p) --> 1). Thus, although local maxima in sensitivity can be encountered as M(o) levels increase, because as M(o) increases each f(p) --> 1, then increasing M(o) levels generally tend to reduce sensitivity in M(o) levels to changes in relative humidity and temperature. Experiments designed to elucidate the potential magnitudes of the effects of relative humidity and temperature on M(o) levels must be carried out at M(o) levels that are relevant for the ambient atmosphere: The f(p) values for the important partitioning compounds must not be elevated above ambient-relevant values. Systems in which M(o) levels are low (e.g., 1-2 microg m(-3)) and/or composed of unaged secondary organic aerosol are the ones most likely to show sensitivity to changing relative humidity and temperature. Results from two published chamber studies are examined in the above regard: [Warren B, et al. (2009) Atmos Environ 43:1789-1795] and [Prisle NL, et al. (2010) Geophys Res Lett 37:L01802].

  11. Methods for treating and conditioning of 14C containing health care waste

    International Nuclear Information System (INIS)

    Health care radioactive waste was previously accepted at Necsa and disposed of on this site in near-surface trenches. This practice was terminated by the regulator during 1997 and since then waste drums have been stored and have now become a Necsa liability. These waste drums containing unknown quantities of 14C. About 2500 drums have been accumulated over the years at the Necsa site. The 14C and 3H contents could not be determined with non-destructive assay methods. A study to minimize the further accumulation of 14C containing health care waste was undertaken and some new regulations implemented to prevent further increase of the liability.The bio-hazardous nature of the waste proved to be the main complication in the development of appropriate characterization and conditioning methods. Possible methods to sterilize the waste as a first step were consequently investigated, and this regards two interesting options received attention. The first was the so-called Stericycle ETD process, during which the waste is shredded in an enclosed environment and then sterilized by means of a technique known as Electro Thermal De-activation, and the second was sterilization with Gamma rays. The latter method had the advantage that shredding and repacking were not required.Once the waste was sterilized the waste could be characterized. The most practical method to do this was to compact the drum in a supercompactor and to analyze the liquid released from the drum during compaction in a laboratory.Reasonably accurate estimates of the 14C contents of the waste packages were obtained in this way and at the same time the waste volume to be disposed of was reduced by at least a factor of four. The option to dispose of the waste without doing any quantification of the 14C was also investigated. This option does not require the waste drums to be opened and therefore no sterilization is required. Characterization is in this case limited to assaying the drums for nuclides that can be

  12. Multiple Comorbid Conditions among Middle-Aged and Elderly Hemophilia Patients: Prevalence Estimates and Implications for Future Care

    Directory of Open Access Journals (Sweden)

    Aroub A. Khleif

    2011-01-01

    Full Text Available Introduction. Advances in hemophilia care and treatment have led to increases in the life expectancy among hemophiliacs. As a result, persons with hemophilia are reaching an older age and experiencing various age-related health conditions never seen before in this population. Aim. To determine the prevalence of comorbidities among middle-aged and elderly hemophilia A and hemophilia B patients. Methods. Retrospective chart review among all hemophilia patients, who attended the Gulf States Hemophilia and Thrombophilia Center. Results. All patients had at least one comorbid condition other than hemophilia, and the majority had between 3 and 6 comorbidities. The most common conditions identified were chronic hepatitis C, hypertension, HIV, chronic arthropathy, and overweight/obesity. Conclusions. Since persons with comorbidities are more likely to have poorer health outcomes and require greater care in managing their health needs, caring for aging hemophiliacs is likely to pose various social and economic challenges for both patients and providers.

  13. Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences

    Science.gov (United States)

    2014-01-01

    Background Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented. FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada. Discussion The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC. Summary Working partnerships between the public health sector and community based organisations

  14. The evidence base for professional and self-care prevention - caries, erosion and sensitivity

    Science.gov (United States)

    2015-01-01

    Background The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures. Methods A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinavian and all age groups were considered. The reference lists of the selected papers were hand-searched for additional review articles of potential interest. Meta-analyses, guidelines and treatment recommendations were considered only when SR's were lacking. In the event of updates or multiple systematic reviews covering the same topic, only the most recent article was included. No quality assessment of the systematic reviews was carried out. The quality of evidence was rated in four levels according to the GRADE scale. Results In total, 39 SR were included. For primary caries prevention, the quality of evidence was high for the use of fluoride toothpaste (with and without triclosan) and moderate for fluoride varnish and fissure sealants. The quality of evidence for fluoride gel, fluoride mouth rinse, xylitol gums and silver diamine fluoride (SDF) was rated as low. For secondary caries prevention and caries arrest, only fluoride interventions and SDF proved consistent benefits, although the quality of evidence was low. Likewise, the GRADE score for preventing erosions located in the enamel with fluoride supplements was low. The quality of evidence for various professional and self-care methods to prevent and manage dentine hypersensitivity was very low. Conclusions There are knowledge gaps in many domains of cariology and preventive dentistry that must be addressed and bridged through clinical research of good quality. PMID:26392204

  15. Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

    Directory of Open Access Journals (Sweden)

    Anasua Deb

    2016-05-01

    Full Text Available Background: Strict asepsis is necessary in operating theatres (OT and intensive care units (ICU as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC units provide a niche for proliferation of fungi and production of fungal spores. Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods. Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate. Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals. [Int J Res Med Sci 2016; 4(5.000: 1583-1589

  16. Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses?

    Science.gov (United States)

    Borg, Charmaine; Bosman, Renske C; Engelhard, Iris; Olatunji, Bunmi O; de Jong, Peter J

    2016-01-01

    Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task to assess participants' motivation-to-eat the actual food items (conditioned stimuli, CS). Food items served as CS and film excerpts of a woman vomiting served as unconditioned stimuli (US). Following acquisition the CS+ (neutral CS paired with US disgust) was rated as more disgusting and less positive. Notably, the conditioned response was transferred to the actual food items as evidenced by participants' reported lowered willingness-to-eat. Participants also showed heightened EMG activity in response to the CS+ which seemed driven by the corrugator indexing a global negative affect. These findings suggest that classical conditioning as a pathway of disgust learning can be reliably observed in subjective but not in disgust-specific physiological responding.

  17. Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo.

    Directory of Open Access Journals (Sweden)

    Sibylle Gerstl

    Full Text Available INTRODUCTION: The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care. METHODOLOGY: Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. FINDINGS: The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%; 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27 and 79% to the drug prices (maximum amount of US$ 1.10. Six percent opted for free consultations and 19% for free drugs. CONCLUSIONS: Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.

  18. Depression, sense and sensitivity: on pre-diagnostic questioning about self-harm and suicidal inclination in the primary care consultation.

    Science.gov (United States)

    Miller, Paul K

    2013-01-01

    National Health Service directives in the UK specify that, in any primary care consultation where a patient either demonstrably has--or is suspected to have--depression, a 'direct question' should be asked regarding their thoughts or activities relating to self-harm or suicide. The evidence collected for this study, which takes the form of recorded interactions between doctors and patients in primary care settings, indicates that this is most commonly done post-diagnosis as an exercise in 'risk assessment' Suicidal ideation, however, is not only classified as a possible outcome of depression but also a core symptom of the condition and, consequently, such a question is sometimes asked prior to the diagnostic phase of the consultation, as a key step in reaching a depression diagnosis. This specific activity presents a general practitioner with an inferably difficult communicative task: how to raise the matter of suicide/self-harm when the patient does not already have a depression diagnosis as an interactional resource with which to make sense of its local relevance. Herein, using a conversation analytic method, techniques employed by general practitioners and patients in negotiating three of these potentially sensitive moments are examined. Analytic observations are then used to highlight a range of issues pertinent to the formulation of normative frames of 'good practice' in handling difficult clinical topics in situ. PMID:24851516

  19. System-state and operating condition sensitive control method and apparatus for electric power delivery systems

    Science.gov (United States)

    Burns, III, William Wesley (Inventor); Wilson, Thomas George (Inventor)

    1978-01-01

    This invention provides a method and apparatus for determining a precise switching sequence for the power switching elements of electric power delivery systems of the on-off switching type and which enables extremely fast transient response, precise regulation and highly stable operation. The control utilizes the values of the power delivery system power handling network components, a desired output characteristic, a system timing parameter, and the externally imposed operating conditions to determine where steady state operations should be in order to yield desired output characteristics for the given system specifications. The actual state of the power delivery system is continuously monitored and compared to a state-space boundary which is derived from the desired equilibrium condition, and from the information obtained from this comparison, the system is moved to the desired equilibrium condition in one cycle of switching control. Since the controller continuously monitors the power delivery system's externally imposed operating conditions, a change in the conditions is immediately sensed and a new equilibrium condition is determined and achieved, again in a single cycle of switching control.

  20. High sensitivity point-of-care device for direct virus diagnostics

    DEFF Research Database (Denmark)

    Kiilerich-Pedersen, Katrine; Dapra, Johannes; Cherré, Solène;

    2013-01-01

    or at the patient's bedside. Conventional diagnostic methods are time consuming, expensive and require specialized laboratory facilities. We present a highly sensitive, highly specific, and low cost platform to test for acute virus infections in less than 15. min, employing influenza A virus (H1N1) as an example...... of its usability. An all polymer microfluidic system with a functionalized conductive polymer (PEDOT-OH:TsO) microelectrode array was developed and exploited for label free and real time electrochemical detection of intact influenza A virus (H1N1) particles. DNA aptamers with affinity for influenza...... A virus (H1N1) were linked covalently to the conductive polymer microelectrodes in the microfluidic channel. Based on changes in the impedance when virions were captured by immobilized probes, we could detect clinically relevant concentrations of influenza A virus (H1N1) in saliva. This is a new, stable...

  1. Sensitive Periods of Emotion Regulation: Influences of Parental Care on Frontoamygdala Circuitry and Plasticity.

    Science.gov (United States)

    Gee, Dylan G

    2016-09-01

    Early caregiving experiences play a central role in shaping emotional development, stress physiology, and refinement of limbic circuitry. Converging evidence across species delineates a sensitive period of heightened neuroplasticity when frontoamygdala circuitry is especially amenable to caregiver inputs early in life. During this period, parental buffering regulates emotional behaviors and stress physiology as emotion regulation circuitry continues to mature. By contrast, disorganized or poor quality caregiving has profound and lasting consequences on the maturation of frontoamygdala circuitry essential for emotion regulation, even following termination of this early life stressor (e.g., adoption from orphanage). This article highlights how interactions between caregiving experiences and the biological state of the developing brain have broad implications for long-term health. PMID:27589500

  2. Forging partnerships between rural women with chronic conditions and their health care providers.

    Science.gov (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth

    2011-03-01

    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  3. Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland

    Directory of Open Access Journals (Sweden)

    Huber CA

    2014-10-01

    Full Text Available Carola A Huber,1 Peter Diem,2 Matthias Schwenkglenks,3 Roland Rapold,1 Oliver Reich1 1Department of Health Sciences, Helsana Group, Zürich, Switzerland; 2Department of Endocrinology, Diabetes and Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; 3Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland Background: Estimating the prevalence of comorbidities and their associated costs in patients with diabetes is fundamental to optimizing health care management. This study assesses the prevalence and health care costs of comorbid conditions among patients with diabetes compared with patients without diabetes. Distinguishing potentially diabetes- and nondiabetes-related comorbidities in patients with diabetes, we also determined the most frequent chronic conditions and estimated their effect on costs across different health care settings in Switzerland. Methods: Using health care claims data from 2011, we calculated the prevalence and average health care costs of comorbidities among patients with and without diabetes in inpatient and outpatient settings. Patients with diabetes and comorbid conditions were identified using pharmacy-based cost groups. Generalized linear models with negative binomial distribution were used to analyze the effect of comorbidities on health care costs. Results: A total of 932,612 persons, including 50,751 patients with diabetes, were enrolled. The most frequent potentially diabetes- and nondiabetes-related comorbidities in patients older than 64 years were cardiovascular diseases (91%, rheumatologic conditions (55%, and hyperlipidemia (53%. The mean total health care costs for diabetes patients varied substantially by comorbidity status (US$3,203–$14,223. Patients with diabetes and more than two comorbidities incurred US$10,584 higher total costs than patients without comorbidity. Costs were significantly higher in patients with

  4. Discrepancies in assessing home care workers’ working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels

    OpenAIRE

    Andersen, Gunn Robstad; Westgaard, Rolf Harald

    2015-01-01

    Background: The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore pot...

  5. Patients Suspected of Irritable Bowel Syndrome-Cross-Sectional Study Exploring the Sensitivity of Rome III Criteria in Primary Care

    DEFF Research Database (Denmark)

    Engsbro, Anne Line; Begtrup, Luise Mølenberg; Kjeldsen, Jens;

    2013-01-01

    The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many...... general practitioners (GPs) have no or limited knowledge of the diagnostic criteria, few use them, and many consider IBS a diagnosis of exclusion. The aim of this study is to explore the sensitivity of the Rome III criteria in relation to a GP-based clinical diagnosis of IBS, to identify differences...... between Rome III-positive and -negative patients, and to describe the agreement between the various symptom-based criteria....

  6. Proteomic characterization of a temperature-sensitive conditional lethal in Drosophila melanogaster

    DEFF Research Database (Denmark)

    Pedersen, Kamilla Sofie; Codrea, M.C; Vermeulen, Corneel;

    2010-01-01

    Genetic variation that is expressed only under specific environmental conditions can contribute to additional adverse effects of inbreeding if environmental conditions change. We present a proteomic characterization of a conditional lethal found in an inbred line of Drosophila melanogaster. The l......-line in response to the restrictive temperature, supporting phenotypic observations of moribund muscle hyper-contraction........ The lethal effect is apparent as a large increase in early mortality at the restrictive temperature (29 °C) as opposed to normal survival at the permissive temperature (20 °C). The increased mortality in response to the restrictive temperature is probably caused by a single recessive major locus....... A quantitative trait locus (QTL) region segregating variation affecting the lethal effect has been identified, allowing for a separation of primary/causal effects and secondary consequences in the proteome expression patterns observed. In this study, the proteomic response to the restrictive temperature...

  7. Precipitation-climate sensitivity to initial conditions in an atmospheric general circulation model

    Energy Technology Data Exchange (ETDEWEB)

    Covey, C., LLNL

    1997-03-01

    Atmospheric climate, in contrast to weather, is traditionally considered to be determined by boundary conditions such as sea surface temperature (SST). To test this hypothesis, we examined annual mean precipitation from an ensemble of 20 general circulation model (GCM) simulations. Ensemble members were forced with identical 10-year series of SST and sea ice, but they began with slightly differing initial conditions. A surprisingly small proportion of the variance in the output is attributable to the effects of boundary forcing. This result-and similar evidence from smaller ensembles of other GCM simulations-implies that long-term precipitation variations are mostly unpredictable, even if SST forecasts are `perfect.`

  8. Omission of expected reward sensitizes the brain dopaminergic system of classically conditioned Atlantic salmon

    DEFF Research Database (Denmark)

    Vindas, M.A.; Höglund, Erik; Folkedal, O.;

    in fishes. Here we show that the omission of expected reward (OER) leads to increased aggression towards conspecifics in classically conditioned Atlantic salmon (Salmo salar). Furthermore, in response to an acute stressor, OER fish displayed increased dopaminergic (DA) neurotransmission compared to controls....... There was also a general downregulation of dopamine receptor D1 gene expression in the telencephalon of OER groups, which suggests a coping mechanism in response to unbalanced DA metabolism. These results indicate that animals subjected to unpredictable reward conditions develop a senzitation of the DA...

  9. 42 CFR 485.711 - Condition of participation: Plan of care and physician involvement.

    Science.gov (United States)

    2010-10-01

    ... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard.... (1) For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services. (2) The plan of care for...

  10. [Molecular epidemiologic surveillance and antifungal agent sensitivity of Candida albicans isolated from anesthesia intensive care units].

    Science.gov (United States)

    Gülay, Zeynep; Ergon, Cem; Ozkütük, Aydan; Yücesoy, Mine; Biçmen, Meral

    2002-01-01

    Patients in intensive care units (ICU) are at risk of nosocomial infections. The incidence of nosocomial fungal infections has increased in parallel with the increase of nosocomial infections. Candida albicans is the most frequent pathogenic species among the fungi. The aim of this study was to make an epidemiological surveillance of C. albicans urine isolates which were isolated from patients who were hospitalized in ICU between June 2000 and October 2001 by antifungal susceptibility testing and Randomly Amplified Polymorphic DNA (RAPD) analysis. For this purpose, 38 C. albicans which were isolated from 29 patients were investigated for amphotericin B and fluconazole susceptibility with the microdilution method. The range of minimal inhibitory concentration (MIC) of amphotericin B was between 0.25-1 microgram/ml and MIC50 value was 0.5 microgram/ml and none of the isolates had high (MIC > 1 microgram/ml) MIC values. The MIC values for fluconazole varied between 0.25-16 micrograms/ml and MIC50 value was 1 microgram/ml. While none of the isolates was resistant to fluconazole, two isolates were detected as dose dependent susceptible. RAPD analysis was performed with two different primers in order to investigate clonal relationship, and 22 patterns were detected with one of the primers and 24 patterns were detected with the other. In conclusion, it is thought that the origin of the C. albicans urine isolates were mostly endogenous but exogenous spread might also be considered as isolates that were clonally related were isolated from different patients at the same time interval.

  11. Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses?

    NARCIS (Netherlands)

    Borg, Charmaine; Bosman, Renske C; Engelhard, Iris; Olatunji, Bunmi O; de Jong, Peter J

    2015-01-01

    Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task

  12. QTL mapping of inbreeding-related cold sensitivity and conditional lethality in Drosophila melanogaster

    NARCIS (Netherlands)

    Vermeulen, C. J.; Bijlsma, R.; Loeschcke, V.

    2008-01-01

    Inbreeding depression is a central theme within genetics, and is of specific interest for researchers within evolutionary and conservation genetics and animal and plant breeding. Inbreeding effects are thought to be caused by the joint expression of conditional and unconditional deleterious alleles.

  13. Reasoning Rats: Forward Blocking in Pavlovian Animal Conditioning Is Sensitive to Constraints of Causal Inference

    Science.gov (United States)

    Beckers, Tom; Miller, Ralph R.; De Houwer, Jan; Urushihara, Kouji

    2006-01-01

    Forward blocking is one of the best-documented phenomena in Pavlovian animal conditioning. According to contemporary associative learning theories, forward blocking arises directly from the hardwired basic learning rules that govern the acquisition or expression of associations. Contrary to this view, here the authors demonstrate that blocking in…

  14. Ventriculostomy related infection in intensive care unit:Diagnostic criteria and related conditions

    Institute of Scientific and Technical Information of China (English)

    Sergio Castaño ´Avila; Amaia Quintano Rodero; Ana Tejero Mojena; Alberto Manzano Ramírez; Esther Corral Lozano; Javier Maynar Moliner; Fernando Fonseca San Miguel; Elena Us ´on García; Yolanda Poveda Hern ´andez; Sara Cabañes Daro-Franc ´es; Goiatz Balziskueta Fl ´orez; Noemi Legaristi Martínez

    2016-01-01

    Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related in-fections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (inter-quartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7%area under curve (95%CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.

  15. Plants sensitivity on nickel under different conditions of iron or calcium concentration in the nutrient medium

    Directory of Open Access Journals (Sweden)

    Renata Matraszek

    2013-12-01

    Full Text Available The sensitivity of six vegetable plants on nickel at early stages of their growth was investigated by index of tolerance. Besides the possibility of nickel fitostabilization by additional application of iron or calcium was tested. The experiment was conducted on Petri dishes. Different concentrations of nickel (0; 0,03; 0,06mM Ni as nickel sulphate, iron (0,05; O,OlmM Fe as Fe2+ citrate and calcium (0,50; 0,75; lmM Ca as calcium carbonate were added. Taking into consideration the sensitivity, investigated vegetables can be ordered in the following way: Cucurbita pepo conv. giromontiina L.>Lactuca sativa L.>Sinapis alba L.>Spinacia oleracea L.=Zea mays var. saccharata Kcke.>Phaseolus vulgaris L. Positive, statistically significant effect ofnickel fitostabilization (0,03 or 0,06mM Ni on elongative growth by the iron application (0,10mM Fe was shown for Zea mays var. saccharata Kcke independently of Ni concentration in the nutrient medium as well as for Sinapis alba L. and Phaseolus vulgaris L. in 0,06mM Ni. Addition as much as 0,75mM Ca in the presence 0,03mM Ni had positive result on Sinapis alba L and Phaseolus vulgaris L. seedlings as well as on Zea mays var. saccharata Kcke and Lactuca sativa L. roots and Cucurbita pepo convar. giromontiina L. shoots. Addition of 0,75mM Ca in the presence 0,06mM Ni promoted elongative growth of Zea mays var. saccharata Kcke seedlings. Application lmM Ca resulted in the promotion of elongative growth of Zea mays var. saccharata Kcke. roots (0,03mM Ni as well as Spinacia oleracea L. roots (0,06mM Ni.

  16. Effect of antecedent growth conditions on sensitivity of Escherichia coli to chlorine dioxide.

    OpenAIRE

    1982-01-01

    Bacterial resistance to inactivation by antibacterial agents that is induced by the growth environment was studied. Escherichia coli was grown in batch culture and in a chemostat, and the following parameters were varied: type of substrate, growth rate, temperature, and cell density during growth. Low doses (0.75 mg/liter) of chlorine dioxide were used to inactivate the cultures. The results demonstrated that populations grown under conditions that more closely approximated natural aquatic en...

  17. Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

    LENUS (Irish Health Repository)

    Payne, Ann

    2012-02-03

    OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. METHODS: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16\\/29) compared to those with no background history of depression, 33.3% (22\\/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).

  18. Applications of Conditional Nonlinear Optimal Perturbation to the Study of the Stability and Sensitivity of the Jovian Atmosphere

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    A two-layer quasi-geostrophic model is used to study the stability and sensitivity of motions on small-scale vortices in Jupiter's atmosphere. Conditional nonlinear optimal perturbations (CNOPs) and linear singular vectors (LSVs) are both obtained numerically and compared in this paper. The results show that CNOPs can capture the nonlinear characteristics of motions in small-scale vortices in Jupiter's atmosphere and show great difference from LSVs under the condition that the initial constraint condition is large or the optimization time is not very short or both. Besides, in some basic states, local CNOPs are found.The pattern of LSV is more similar to local CNOP than global CNOP in some cases. The elementary application of the method of CNOP to the Jovian atmosphere helps us to explore the stability of variousscale motions of Jupiter's atmosphere and to compare the stability of motions in Jupiter's atmosphere and Earth's atmosphere further.

  19. Relationship between absorptive lenses and contrast sensitivity in healthy young subjects with glare under photopic- and mesopic-vision conditions

    Science.gov (United States)

    Kanazawa, Masatsugu; Uozato, Hiroshi

    2013-05-01

    We investigated the effect of absorptive lenses on contrast sensitivity under photopic- and mesopic-visions with glare, from the viewpoint of luminous transmittance (LT) and spectral transmittance. The subjects were 24 healthy volunteers. Log contrast sensitivity (logCS) under two luminance conditions with glare was measured with a contrast glare test device. Binocular logCSs with absorptive lenses were compared with those without absorptive lenses (control condition). Furthermore, to investigate the effect of spectral transmittance, we calculated the ratio of stimulus quantity and the correlation between this ratio and logCS. Compared with that in the control, logCS was hardly affected in the case of high-luminous-transmittance absorptive lenses under binocular visions with glare. Middle- and long-wavelength lights effectively contribute to contrast sensitivity under photopic-vision and lights at each wavelength showed almost the same coefficients of correlation under mesopic-vision. Previous studies suggested that absorptive lenses provide users with protection against harmful radiation and glare. Our present results suggested that short-wavelength and high-LT absorptive lenses are particularly useful in daylight.

  20. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

    2016-08-01

    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance. PMID:27503976

  1. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

    2016-08-01

    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance.

  2. Audio-visual speech timing sensitivity is enhanced in cluttered conditions.

    Directory of Open Access Journals (Sweden)

    Warrick Roseboom

    Full Text Available Events encoded in separate sensory modalities, such as audition and vision, can seem to be synchronous across a relatively broad range of physical timing differences. This may suggest that the precision of audio-visual timing judgments is inherently poor. Here we show that this is not necessarily true. We contrast timing sensitivity for isolated streams of audio and visual speech, and for streams of audio and visual speech accompanied by additional, temporally offset, visual speech streams. We find that the precision with which synchronous streams of audio and visual speech are identified is enhanced by the presence of additional streams of asynchronous visual speech. Our data suggest that timing perception is shaped by selective grouping processes, which can result in enhanced precision in temporally cluttered environments. The imprecision suggested by previous studies might therefore be a consequence of examining isolated pairs of audio and visual events. We argue that when an isolated pair of cross-modal events is presented, they tend to group perceptually and to seem synchronous as a consequence. We have revealed greater precision by providing multiple visual signals, possibly allowing a single auditory speech stream to group selectively with the most synchronous visual candidate. The grouping processes we have identified might be important in daily life, such as when we attempt to follow a conversation in a crowded room.

  3. Design and Application of a High Sensitivity Piezoresistive Pressure Sensor for Low Pressure Conditions.

    Science.gov (United States)

    Yu, Huiyang; Huang, Jianqiu

    2015-09-08

    In this paper, a pressure sensor for low pressure detection (0.5 kPa-40 kPa) is proposed. In one structure (No. 1), the silicon membrane is partly etched to form a crossed beam on its top for stress concentration. An aluminum layer is also deposited as part of the beam. Four piezoresistors are fabricated. Two are located at the two ends of the beam. The other two are located at the membrane periphery. Four piezoresistors connect into a Wheatstone bridge. To demonstrate the stress concentrate effect of this structure, two other structures were designed and fabricated. One is a flat membrane structure (No. 2), the other is a structure with the aluminum beam, but without etched silicon (No. 3). The measurement results of these three structures show that the No.1 structure has the highest sensitivity, which is about 3.8 times that of the No. 2 structure and 2.7 times that of the No. 3 structure. They also show that the residual stress in the beam has some backside effect on the sensor performance.

  4. Serotonin (2C) receptor regulation of cocaine-induced conditioned place preference and locomotor sensitization

    OpenAIRE

    Craige, Caryne P.; Unterwald, Ellen M.

    2012-01-01

    Previous studies have identified an inhibitory regulatory role of the 5-HT2C receptor in serotonin and dopamine neurotransmission. As cocaine is known to enhance serotonin and dopamine transmission, the ability of 5-HT2C receptors to modulate cocaine-induced behaviors was investigated. Alterations in cocaine reward behavior were assessed in the conditioned place preference (CPP) paradigm. Mice were injected with a selective 5-HT2C receptor agonist, Ro 60-0175 (0, 1, 3, 10 mg/kg, i.p.) prior t...

  5. Integrated Health Care Payment Methods: Typology, Evidence And Pre-Conditions Of Implementation

    OpenAIRE

    Igor M. Sheiman

    2014-01-01

    Many countries have recently started the search for new payments methods with the specific objective to encourage integration in health care delivery – teamwork of providers, their coordination and continuity of care. This paper suggests the typology of three major integrated payment methods – pay-for-performance, episode based bundled payment and global payment. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of thei...

  6. Pavlovian conditioning and cross-sensitization studies raise challenges to the hypothesis that overeating is an addictive behavior.

    Science.gov (United States)

    Harb, M R; Almeida, O F X

    2014-04-29

    Elevated glucocorticoid levels and sign tracking (ST) in Pavlovian conditioning are potential biomarkers of compulsive behaviors such as addiction. As overeating is sometimes viewed as a form of addictive behavior, we hypothesized that murine Pavlovian sign trackers would have a greater propensity to overeat and develop obesity. Using a food reward in the classical conditioning paradigm, we show that ST behavior is a robust conditioned response but not a predictor of eating and growth trajectories in mice, thus challenging the view that the development of obesity and drug addiction depend on identical mechanisms. This interpretation was supported by experiments which showed that overweight mice do not display cross-sensitization to an addictive drug (morphine), and conversely, that overweight morphine-sensitized animals do not overconsume a highly rewarding food. Although the rewarding/motivational effects of both food and drugs of abuse are mediated by similar neurochemical mechanisms, obesity and drug addiction represent a summation of other dysfunctional input and output pathways that lead to the emergence of two distinct disorders, each of which would deserve a specific pharmacotherapeutic approach.

  7. Behavioural responses to thermal conditions affect seasonal mass change in a heat-sensitive northern ungulate.

    Directory of Open Access Journals (Sweden)

    Floris M van Beest

    Full Text Available BACKGROUND: Empirical tests that link temperature-mediated changes in behaviour (activity and resource selection to individual fitness or condition are currently lacking for endotherms yet may be critical to understanding the effect of climate change on population dynamics. Moose (Alces alces are thought to suffer from heat stress in all seasons so provide a good biological model to test whether exposure to non-optimal ambient temperatures influence seasonal changes in body mass. Seasonal mass change is an important fitness correlate of large herbivores and affects reproductive success of female moose. METHODOLOGY/PRINCIPAL FINDINGS: Using GPS-collared adult female moose from two populations in southern Norway we quantified individual differences in seasonal activity budget and resource selection patterns as a function of seasonal temperatures thought to induce heat stress in moose. Individual body mass was recorded in early and late winter, and autumn to calculate seasonal mass changes (n = 52 over winter, n = 47 over summer. We found large individual differences in temperature-dependent resource selection patterns as well as within and between season variability in thermoregulatory strategies. As expected, individuals using an optimal strategy, selecting young successional forest (foraging habitat at low ambient temperatures and mature coniferous forest (thermal shelter during thermally stressful conditions, lost less mass in winter and gained more mass in summer. CONCLUSIONS/SIGNIFICANCE: This study provides evidence that behavioural responses to temperature have important consequences for seasonal mass change in moose living in the south of their distribution in Norway, and may be a contributing factor to recently observed declines in moose demographic performance. Although the mechanisms that underlie the observed temperature mediated habitat-fitness relationship remain to be tested, physiological state and individual variation in

  8. Reversal of apomorphine locomotor sensitization by a single post-conditioning trial treatment with a low autoreceptor dose of apomorphine: a memory re-consolidation approach.

    Science.gov (United States)

    Carrera, Marinete Pinheiro; Carey, Robert J; Dias, Flávia Regina Cruz; de Matos, Liana Wermelinger

    2011-07-01

    Sensitization is a common feature of psychostimulants and sensitization effects are generally considered to be linked to the addictive properties of these drugs. We used a conventional paired/unpaired Pavlovian protocol to induce a context specific sensitization to the locomotor stimulant effect of a high dose of apomorphine (2.0mg/kg). Two days following a 5 session sensitization induction phase, a brief 5min non-drug test for conditioning was conducted. Only the paired groups exhibited locomotor stimulant conditioned response effects. Immediately following this brief test for conditioning, the paired and the unpaired groups received injections of 0.05mg/kg apomorphine, 2.0mg/kg apomorphine or vehicle designed to differentially impact memory re-consolidation of the conditioning. Two days later, all groups received a sensitization challenge test with 2.0mg/kg apomorphine. The 2.0mg/kg apomorphine post-trial treatment potentiated sensitization while the 0.05mg/kg eliminated sensitization. These effects were only observed in the paired groups. The activation of dopaminergic systems by the high dose of apomorphine strengthened the drug/environment association whereas the inhibition of dopamine activity by the low auto-receptor dose eliminated this association. The results point to the importance of conditioning to context specific sensitization and targeting memory re-consolidation of conditioning as a paradigm to modify sensitization.

  9. Electricity Bill Savings from Residential Photovoltaic Systems: Sensitivities to Changes in Future Electricity Market Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Barbose, Galen; Wiser, Ryan

    2013-01-09

    This scoping study investigates the impact of, and interactions among, three key sources of uncertainty in the future value of bill savings from customer-sited PV, focusing in particular on residential customers. These three sources of uncertainty are: changes to electricity market conditions that would affect retail electricity prices, changes to the types of retail rate structures available to residential customers with PV, and shifts away from standard net-metering toward other compensation mechanisms for residential PV. We investigate the impact of a range of electricity market scenarios on retail electricity prices and rate structures, and the resulting effects on the value of bill savings from PV. The scenarios include various levels of renewable and solar energy deployment, high and low natural gas prices, the possible introduction of carbon pricing, and greater or lesser reliance on utility-scale storage and demand response. We examine the bill savings from PV with time-invariant, flat residential retail rates, as well as with time-varying retail rates, including time-of-use (TOU) rates and real-time pricing (RTP). In addition, we explore a flat rate with increasing-block pricing (IBP). We evaluate the bill savings from PV with net metering, as currently allowed in many states, as well as scenarios with hourly netting, a partial form of net metering. This scoping study is the first known effort to evaluate these types of interactions in a reasonably comprehensive fashion, though by no means have we considered every possible change to electricity market conditions, retail rate structures, or PV compensation mechanisms. It focuses solely on the private value of bill savings for residential PV and does not seek to quantify the broader social or economic cost or value of solar electricity. Our analysis applies assumptions based loosely on California’s electricity market in a future year (2030); however, it is neither intended to forecast California’s future

  10. Electricity Bill Savings from Residential Photovoltaic Systems: Sensitivities to Changes in Future Electricity Market Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Barbose, Galen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2013-01-09

    Customer-sited photovoltaic (PV) systems in the United States are often compensated at the customer’s underlying retail electricity rate through net metering. Calculations of the customer economics of PV, meanwhile, often assume that retail rate structures and PV compensation mechanisms will not change and that retail electricity prices will increase (or remain constant) over time, thereby also increasing (or keeping constant) the value of bill savings from PV. Given the multitude of potential changes to retail rates and PV compensation mechanisms in the future, however, understanding how such changes might impact the value of bill savings from PV is critical for policymakers, regulators, utilities, the solar industry, and potential PV owners, i.e., any stakeholder interested in understanding uncertainties in and potential changes to the long-term customer economics of PV. This scoping study investigates the impact of, and interactions among, three key sources of uncertainty in the future value of bill savings from customer-sited PV, focusing in particular on residential customers. These three sources of uncertainty are: changes to electricity market conditions that would affect retail electricity prices, changes to the types of retail rate structures available to residential customers with PV, and shifts away from standard net-metering toward other compensation mechanisms for residential PV.

  11. Perfect storm: organizational management of patient care under natural disaster conditions.

    Science.gov (United States)

    McCaughrin, William Cass; Mattammal, Maria

    2003-01-01

    Managing uncertainty is an essential attribute of organizational leadership and effectiveness. Uncertainty threatens optimal decision making by managers and, by extension, reduces the quality of patient care. Variation in the work flows of everyday patient caregiving reflects management's steps to control uncertainty, which include strategies for contending with potential disaster scenarios. Little exists in the literature that reveals how management's strategic response to controlling uncertainty in a real disaster event differs from strategies practiced in disaster simulations, with the goal of protecting patient care. Using organization theory, this article presents the application of uncertainty management to the catastrophic flooding of a major teaching hospital. A detailed description of management's strategies for patient rescue and evacuation is provided. Unique aspects of managing uncertainty stemming from a natural disaster are highlighted. Recommendations on organization responses to disasters that optimize patient care, safety, and continuity are offered to managers. PMID:14552099

  12. A quantitative sensitivity analysis on the behaviour of common thermal indices under hot and windy conditions in Doha, Qatar

    Science.gov (United States)

    Fröhlich, Dominik; Matzarakis, Andreas

    2016-04-01

    Human thermal perception is best described through thermal indices. The most popular thermal indices applied in human bioclimatology are the perceived temperature (PT), the Universal Thermal Climate Index (UTCI), and the physiologically equivalent temperature (PET). They are analysed focusing on their sensitivity to single meteorological input parameters under the hot and windy meteorological conditions observed in Doha, Qatar. It can be noted, that the results for the three indices are distributed quite differently. Furthermore, they respond quite differently to modifications in the input conditions. All of them show particular limitations and shortcomings that have to be considered and discussed. While the results for PT are unevenly distributed, UTCI shows limitations concerning the input data accepted. PET seems to respond insufficiently to changes in vapour pressure. The indices should therefore be improved to be valid for several kinds of climates.

  13. Short-run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization

    OpenAIRE

    Jessamyn Schaller; Ann Huff Stevens

    2014-01-01

    Job loss in the United States is associated with long-term reductions in income and long-term increases in mortality rates. This paper examines the short- to medium-term changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 9800 individual job losses and longitudinal data on a wide variety of health-related measures and outcomes, we show that job loss results in worse self-reported health, includin...

  14. Development of volatile compounds during storage of different skin care products at various conditions

    DEFF Research Database (Denmark)

    Horn, A. F.; Thomsen, Birgitte Raagaard; Hyldig, Grethe;

    stored in the homes of consumers skin care products may be exposed to relatively high temperatures and light. Hence, especially skin care products sold in countries with a warm climate can undergo lipid oxidation and develop volatile compounds with off-odours. This presentation will include results from...... chromatography-mass spectrometry and peroxide value, and compared to samples stored at 2°C in the dark. In addition, sensory analyses were carried out to assess the off-odours developed in the samples....

  15. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    S Thakur

    2016-01-01

    Full Text Available Background: There is not much published literature on neonatal septicemia available for the Sub-Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1-year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49% and 96 (51% were late onset sepsis. Gram-positive isolates were 60% and 40% were Gram-negative. Staphylococcus aureus (40%, coagulase negative Staphylococcus species (16%, non-fermenter group of organisms (NFGOs (15%, and Klebsiella pneumoniae (10% were the main isolates. Nasal cannula 101 (54%, birth asphyxia 91 (48%, and prematurity 73 (38% were the prominent risk factors associated with septicemia. Gram-positive organisms were highly resistant to penicillin (87% whereas Gram-negative isolates showed high resistance to third generation cephalosporins (53–89% and aminoglycosides (50–67%. The S. aureus isolates were methicillin-resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram-negative isolates.Conclusion: Our study highlights the recent emergence of Gram-positive organisms as predominant cause of neonatal septicemia in this part of Sub-Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram-negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

  16. Critical System Cascading Collapse Assessment for Determining the Sensitive Transmission Lines and Severity of Total Loading Conditions

    Directory of Open Access Journals (Sweden)

    Nur Ashida Salim

    2013-01-01

    Full Text Available This paper presents a computationally accurate technique used to determine the estimated average probability of a system cascading collapse considering the effect of hidden failure on a protection system. This includes an accurate calculation of the probability of hidden failure as it will give significant effect on the results of the estimated average probability of system cascading collapse. The estimated average probability of a system cascading collapse is then used to determine the severe loading condition contributing to a higher risk of a system cascading collapse. This information is important because it will assist the utility to determine the maximum level of increase in the system loading condition before the occurrence of critical power system cascading collapse. Furthermore, the initial tripping of sensitive transmission line contributing to a critical system cascading collapse can also be determined by using the proposed method. Based on the results obtained from this study, it was found that selecting the accurate probability of hidden failure is very important as it will affect the estimated average probability of a system cascading collapse. Comparative study has been done with other techniques to verify the effectiveness of the proposed method used in the determination of sensitive transmission lines.

  17. On the added value and sensitivity of WRF to driving conditions over CORDEX-Africa domain

    Science.gov (United States)

    Lorente-Plazas, Raquel; García-Díez, Markel; Jimenez-Guerrero, Pedro; Fernández, Jesús; Montavez, Juan Pedro

    2014-05-01

    The assessment of the climate variability over Africa has recently attracted the interest of the regional climate downscaling research community. The main reasons are not only because Africa is a climate change hot-spot, but also due to the low capacity of this region for the adaptation and mitigation under negative impacts and its direct dependency on its socio-economic sustainability of the climate variability. Therefore, improvements in the understanding of the African climate could help the governments in decision-making. Under this umbrella, regional climate models (RCMs) are promising tools to assess the African regional climate. The main advantage of the RCMs, with respect to global reanalysis datasets, is the higher detail provided by the increased resolution which implies a better representation of land-surface interactions and atmospheric processes. However, the confidence on the RCMs strongly depends on the reduction/bounding of uncertainties. One of these sources of uncertainties is associated with the selection of the boundary conditions for driving the regional models. In this work, two identical CORDEX-compliant simulations have been performed over Africa with the unique difference of being driven by two different reanalyses. The reanalyses used were the European Centre for Medium Range Weather Forecasts Interim reanalysis (ERA-I) and the Japanese 25-year reanalysis (JRA-25) by the Japanese Meteorological Service. Both reanalyses have identical temporal resolution (6-hr) but different spatial grid resolution, 0.75 and 1.25 degrees, respectively. The regional model used was the Weather Research and Forecasting Model (WRF). The numerical experiments encompass the period 1989-2010 covering the Africa-CORDEX domain with a 50 km horizontal spatial resolution and 28 vertical levels up to 50 hPa. The WRF simulations are compared between them and against observations. For the mean and maximum temperature the CRU monthly time series (0.25deg) from Climatic

  18. Modeling responses of Daphnia magna to pesticide pulse exposure under varying food conditions: intrinsic versus apparent sensitivity.

    Science.gov (United States)

    Pieters, Barry J; Jager, Tjalling; Kraak, Michiel H S; Admiraal, Wim

    2006-10-01

    Recent studies showed that limiting food conditions resulted in either increased or decreased sensitivity of Daphnia magna to toxicants. It remained unclear whether these contrasting food-dependent alterations in toxicity resulted from differences in intrinsic sensitivity of the daphnids or from changes in toxicokinetics and resource allocation. It is hypothesized here that, if food level only affects accumulation kinetics and resource allocation, then the intrinsic sensitivity to this toxicant should be the same for all food regimes. This hypothesis was investigated using the DEBtox model, which is based on the theory of Dynamic Energy Budgets. We examined results of two recently conducted life-cycle studies on the combined effects of food level and a pulsed exposure to the pyrethroid insecticide fenvalerate (FV) on D. magna. The model described the effects of the time-varying exposure well, and indicated that when the animals did not die from exposure to FV, full reversibility of toxic effects was possible, allowing a complete recovery. Results revealed furthermore that the data from both studies could be described by the same NECs for survival and assimilation, killing rate and tolerance concentration (132 (49.2-228) x 10(-6) microg/L, 0 (0-1.18 x 10(-5)) microg/L, 74.4 (55.6-96.4) L (microg d)(-1) and 5.39 (2.72-18.5) x 10(-3) microg/L, respectively). It is therefore concluded that food-dependent FV toxicity can be explained by altered toxicokinetics and resource allocation, but not by changes in the intrinsic sensitivity of the daphnids. This study implies that the effect of pesticide application in the field depends on the trophic state of the receiving water body, but also that full recovery of survivors is possible after FV application. PMID:17024561

  19. Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India

    Directory of Open Access Journals (Sweden)

    Binod Kumar Patro

    2015-01-01

    Full Text Available Background: Primary care physicians (PCPs encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4 was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

  20. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2012-06-01

    Full Text Available Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57% was predominant organism followed by Klebsiella spp. (22.29%. Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57% is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased. [National J of Med Res 2012; 2(3.000: 354-357

  1. COMMON ORGANISMS AND ANTIBIOTIC SENSITIVITY OF E COLI IN URINARY TRACT INFECTION, IN A TERTIARY CARE TEACHING HOSPITAL, NORTHERN KERALA

    Directory of Open Access Journals (Sweden)

    Shanavas

    2015-11-01

    Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

  2. Effect of operating conditions in soil aquifer treatment on the removals of pharmaceuticals and personal care products.

    Science.gov (United States)

    He, Kai; Echigo, Shinya; Itoh, Sadahiko

    2016-09-15

    Soil aquifer treatment (SAT) is an alternative advanced treatment for wastewater reclamation, and it has the potential to control micropollutants including pharmaceuticals and personal care products (PPCPs). However, the relationship of operating conditions in SAT and removals of micropollutants was not clear. In this study, the effects of operating conditions on the removals of PPCPs were evaluated by using lab-scale columns and plant pilot-scale reactors under different operating conditions. Firstly, weathered granite soil (WGS), standard sand (SAND) and Toyoura standard sand (TS) have different soil characteristics such as total organic carbon (TOC) and cation exchange capacity (CEC). In the columns with these packing materials, the removals of carboxylic analgesics and antilipidemics were effective regardless packing materials. The removals of antibiotics were more effective in WGS than in TS and SAND, indicating high TOC and CEC enhance the sorption in SAT. Secondly, with the extension of hydraulic retention time (HRT), the removals of sulfamethoxazole, acetaminophen, crotamiton, and antipyrine were improved in WGS columns, and adaptable biodegradation for moderately removable PPCPs was formed. Thirdly, the removal efficiencies of sulfamethoxazole and crotamiton were higher in the WGS column under vadose condition than in the WGS column under saturated condition, because of aerobic condition in WGS column under vadose condition. Though long HRT and vadose condition had positive influence on the removals of several PPCPs such as sulfamethoxazole, WGS column with an HRT of 7days under saturated condition removed most PPCPs. PMID:27213846

  3. Behavioral sensitization produced by a single administration of apomorphine: implications for the role of Pavlovian conditioning in the mediation of context-specific sensitization.

    Science.gov (United States)

    Bloise, Enrrico; Carey, Robert J; Carrera, Marinete Pinheiro

    2007-03-01

    The present study examined the minimal number of exposures to the D1/D2 agonist apomorphine capable of producing behavioral sensitization. Rats received one (experiment 1) or two administrations on two successive days (experiment 2) of apomorphine (0.5 and 2.0 mg/kg) paired or unpaired to an open-field environment. After 2 days of drug withdrawal, the rats received a challenge injection with the same dose of apomorphine (sensitization test) and locomotion, rearing and sniffing were measured. The results of the first experiment showed that locomotor sensitization occurred after a single acute exposure to apomorphine and that 0.5 and 2.0 mg/kg treatments were equally effective. This sensitization effect was context-specific and was limited to locomotion. The second experiment revealed a differential dose effect on the sensitization test. Two treatments with 2.0 mg/kg potentiated locomotor sensitization as compared with a single treatment but two treatments with 0.5 mg/kg did not increase the sensitization effect more than the single 0.5 mg/kg treatment. This result indicates an interaction between drug dose and frequency of drug treatment for the induction of apomorphine locomotor sensitization. In that the sensitization effects are considered to be a core contributor to psychostimulant addiction, the present findings are of importance to understanding addiction because they indicate that sensitization processes can be initiated with a single drug experience and amplified with exposure to higher drug dosage levels.

  4. Sensitivity of runoff behaviour of Alpine catchments to system conditions - looking at the current and future situation

    Science.gov (United States)

    Meißl, Gertraud; Klebinder, Klaus; Kerl, Florian; Dobler, Christian; Geitner, Clemens; Schöberl, Friedrich; Kohl, Bernhard; Markart, Gerhard; Sotier, Bernadette; Formayer, Herbert; Goler, Robert; Gorgas, Theresa; Bürger, Gerd; Bronstert, Axel

    2014-05-01

    Alpine settlements are often situated on alluvial fans at the outlet of small catchments. Thus they are - due to the short response time - exposed to a high risk in case of flash floods. Within the project "Sensitivity of the runoff characteristics of small Alpine catchments to climate change" we aim at identifying the critical combinations of event characteristics (intensity and duration of rain) and system conditions (soil moisture, state of vegetation and land use, snow cover) producing flash floods in order to improve the predictability of such events. We have investigated three Alpine catchments in western Austria with different altitudes and precipitation regimes. On the plot scale, field measurements, especially irrigation experiments, revealed that the rainfall-runoff reaction of slopes producing a high or low amount of surface runoff is relatively independent of the actual soil moisture content. However, plots producing a medium amount of surface runoff at dry conditions may generate significantly increased surface runoff volumes at moist conditions. Intensive grazing raises the amount of surface runoff with the duration of pasture season. Event analysis and mapping of the catchment inventories showed that the catchments with low (Ruggbachtal, 400 - 1000 m a.s.l, Vorarlberg) and medium altitude (Brixenbachtal, 800 - 2000 m a.s.l., Tyrol) tend to be sensitive to antecedent precipitation. Due to the high amount of pastured areas, the Brixenbach catchment shows a seasonal variation of runoff behaviour with a maximum of surface runoff in the late summer. The highly situated catchment (Längental, 2000 - 3000 m a.s.l., Tyrol) may show an increased runoff response at rain-on-snow-events. Because of its high portion of rock and talus slopes the runoff reaction of the catchment is quite insensitive to antecedent soil moisture content and grazing intensity. Currently ongoing hydrological modelling will show how seasonal system conditions (duration of snow cover

  5. Modeling regional aerosol variability over California and its sensitivity to emissions and long-range transport during the 2010 CalNex and CARES campaigns

    Directory of Open Access Journals (Sweden)

    J. D. Fast

    2014-03-01

    Full Text Available The performance of the Weather Research and Forecasting regional model with chemistry (WRF-Chem in simulating the spatial and temporal variations in aerosol mass, composition, and size over California is quantified using measurements collected during the California Nexus of Air Quality and Climate Experiment (CalNex and the Carbonaceous Aerosol and Radiative Effects Study (CARES conducted during May and June of 2010. The extensive meteorological, trace gas, and aerosol measurements collected at surface sites and along aircraft and ship transects during CalNex and CARES were combined with operational monitoring network measurements to create a single dataset that was used to evaluate the one configuration of the model. Simulations were performed that examined the sensitivity of regional variations in aerosol concentrations to anthropogenic emissions and to long-range transport of aerosols into the domain obtained from a global model. The configuration of WRF-Chem used in this study is shown to reproduce the overall synoptic conditions, thermally-driven circulations, and boundary layer structure observed in region that controls the transport and mixing of trace gases and aerosols. However, sub-grid scale variability in the meteorology and emissions as well as uncertainties in the treatment of secondary organic aerosol chemistry likely contribute to errors at a primary surface sampling site located at the edge of the Los Angeles basin. Differences among the sensitivity simulations demonstrate that the aerosol layers over the central valley detected by lidar measurements likely resulted from lofting and recirculation of local anthropogenic emissions along the Sierra Nevada. Reducing the default emissions inventory by 50% led to an overall improvement in many simulated trace gases and black carbon aerosol at most sites and along most aircraft flight paths; however, simulated organic aerosol was closer to observed when there were no adjustments to the

  6. Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

    Science.gov (United States)

    Kogan, Alexis Coulourides; Wilber, Kathleen; Mosqueda, Laura

    2016-01-01

    Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment. PMID:26626408

  7. Pairing of Customer’ Satisfaction with Brand Consciousness and Price Sensitivity (A Feminine Study in Pakistan on Beauty Care Products’ selection, Use and Satisfaction

    Directory of Open Access Journals (Sweden)

    Saima Ulfat

    2013-01-01

    Full Text Available This research study targets the role of brand consciousness and price sensitivity in relation with satisfaction of females with their selected beauty care products. Data is collected from both working and non-working females via quota sampling primarily and convenience sampling as sub sampling. Responses of 108 females are collected via online Survey. In presented model, Satisfaction is appearing as dependent variable whereas Brand Consciousness and Price Sensitivity are appearing as independent variables. Gathered data is analyzed while using Correlation Coefficient and Multiple Linear Regression. Results indicate a strongest relation of brand consciousness and price sensitivity along with satisfaction and females association with their selected beauty care products. Significance of this research is that manufacturing companies can use its results in order to enhance their marketing related efforts regarding this category of their brands especially with the context of Pakistani females.

  8. Apomorphine induced conditioned place preference and sensitization is greater in rats exposed to unpredictable chronic mild stress.

    Science.gov (United States)

    Kanwal, Sumera; Ikram, Huma; Farhan, Muhammad; Haleem, Darakhshan Jabeen

    2015-11-01

    CNS stimulants are the class of the drugs that may be used to get relief from depression. Apomorphine is a D1 and D2 receptor agonist with a CNS stimulatory effect used for the treatment of Parkinson's disease is also abused. Although many drugs of abuse produce tolerance and dependence. Long term use of pshycostimulants produce reverse tolerance described as sensitization. These drugs also have a number of other beneficial effects but their therapeutic use is limited because of abuse potential. Conditioned place preference (CPP) test is used to monitor the reinforcing effect of drugs of abuse. Stress is an important factor that precipitates and potentiates addictive effects of different drugs of abuse. The present study was designed to investigate the addictive effect of apomorphine (1mg/kg) in rats previously exposed to repeated unpredictable chronic mild stress for 10 days (animal model of depression). Results from present study illustrate that unpredictable chronic mild stress potentiates the reinforcing effects of apomorphine as the number of entries and the time spent in the CPP compartment associated with drug administration is increased. Motor activity was taken as a parameter for behavioral sensitization which is induced by repeated administration of apomorphine, monitored as the number of cage crossings in light compartment of the CPP apparatus, also increased. PMID:26639488

  9. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  10. Identification of brain nuclei implicated in cocaine-primed reinstatement of conditioned place preference: a behaviour dissociable from sensitization.

    Directory of Open Access Journals (Sweden)

    Robyn Mary Brown

    Full Text Available Relapse prevention represents the primary therapeutic challenge in the treatment of drug addiction. As with humans, drug-seeking behaviour can be precipitated in laboratory animals by exposure to a small dose of the drug (prime. The aim of this study was to identify brain nuclei implicated in the cocaine-primed reinstatement of a conditioned place preference (CPP. Thus, a group of mice were conditioned to cocaine, had this place preference extinguished and were then tested for primed reinstatement of the original place preference. There was no correlation between the extent of drug-seeking upon reinstatement and the extent of behavioural sensitization, the extent of original CPP or the extinction profile of mice, suggesting a dissociation of these components of addictive behaviour with a drug-primed reinstatement. Expression of the protein product of the neuronal activity marker c-fos was assessed in a number of brain regions of mice that exhibited reinstatement (R mice versus those which did not (NR mice. Reinstatement generally conferred greater Fos expression in cortical and limbic structures previously implicated in drug-seeking behaviour, though a number of regions not typically associated with drug-seeking were also activated. In addition, positive correlations were found between neural activation of a number of brain regions and reinstatement behaviour. The most significant result was the activation of the lateral habenula and its positive correlation with reinstatement behaviour. The findings of this study question the relationship between primed reinstatement of a previously extinguished place preference for cocaine and behavioural sensitization. They also implicate activation patterns of discrete brain nuclei as differentiators between reinstating and non-reinstating mice.

  11. Depressive Symptoms in Extended-Care Employees: Children, Social Support, and Work-Family Conditions

    OpenAIRE

    O’Donnell, Emily M.; Ertel, Karen A.; Berkman, Lisa F.

    2011-01-01

    To examine the relation between having a child aged 18 years and under in the home and employee depressive symptoms, we analyzed cross-sectional data from four extended care facilities in Boston, MA (n = 376 employees). Results show that having a child is associated with slightly higher depressive symptoms. The strength of this relationship in our models is attenuated with the inclusion of social support at home (β = 1.08 and β = 0.85, with and without support, respectively) and may differ by...

  12. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    18 or more with type1 or type2 diabetes sampled in a national register of people with diabetes. They were sent a Danish version of the PACIC. Main outcome measures: Data quality (mean, median, item response, missing, floor and ceiling effects), internal consistency (Cronbach's alpha and average...... interitem correlation), item-rest correlations. Model fit from confirmatory factor analysis (CFA). Results: We present the psychometric properties of the questionnaire and the first results evaluating chronic care in Danish people with diabetes. Conclusions: The complexity of validation is greater when...

  13. Fate of Pharmaceuticals and Personal Care Products (PPCPs) in Saturated Soil Under Various Redox Conditions

    Science.gov (United States)

    Dror, I.; Menahem, A.; Berkowitz, B.

    2014-12-01

    The growing use of PPCPs results in their increasing release to the aquatic environment. Consequently, understanding the fate of PPCPs under environmentally relevant conditions that account for dynamic flow and varying redox states is critical. In this study, the transport of two organometallic PPCPs, Gd-DTPA and Roxarsone (As complex) and their metal salts (Gd(NO3)3, AsNaO2), is investigated. The former is used widely as a contrasting agent for MRI, while the latter is applied extensively as a food additive in the broiler poultry industry. Both of these compounds are excreted from the body, almost unchanged chemically. Gadolinium complexes are not fully eliminated in wastewater treatment and can reach groundwater via irrigation with treated wastewater; Roxarsone can enter groundwater via leaching from manure used as fertilizer. Studies have shown that the transport of PPCPs in groundwater is affected by environmental conditions such as redox states, pH, and soil type. For this study, column experiments using sand or Mediterranean red sandy clay soil were performed under several redox conditions: aerobic, nitrate-reducing, iron-reducing, sulfate-reducing, methanogenic, and very strongly chemical reducing. Batch experiments to determine adsorption isotherms were also performed for the complexes and metal salts. We found that Gd-DTPA transport was affected by the soil type and was not affected by the redox conditions. In contrast, Roxarsone transport was affected mainly by the different redox conditions, showing delayed breakthrough curves as the conditions became more biologically reduced (strong chemical reducing conditions did not affect the transport). We also observed that the metal salts show essentially no transport while the organic complexes display much faster breakthrough. The results suggest that transport of these PPCPs through soil and groundwater is determined by the redox conditions, as well as by soil type and the form of the applied metal (as salt

  14. Lessons from Community Mental Health to Drive Implementation in Health Care Systems for People with Long-Term Conditions

    Directory of Open Access Journals (Sweden)

    Michele Tansella

    2014-04-01

    Full Text Available This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency. Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans. We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.

  15. Chloride transport and its sensitivities to different boundary conditions in reclaimed soil solutions filled with fly ash

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yang CHEN; Jia-Ping YAN; Shi-Wen ZHANG

    2013-01-01

    Chloride ion transport in reclaimed soil solutions filled with fly ash (FA) was investigated by measuring the hydraulic parameters (i.e.water retention curves and hydraulic conductivity) of three substrates,namely GSL,GFA,and CFA.Similar simulations were carried out under certain weather conditions.The different boundary conditions of chloride transport were also discussed from FA texture,cover soil thickness,groundwater table level,and initial chloride concentration.Furthcrmore,the sensitivities of chloride ions to these effect factors were analyzed.The results show that the different top soil thickness and initial chloride concentration have no effect on salinity of topsoil solution in the monitoring points,but they can clearly change the chloride concentration of FA layers.The sensibilities from top soil thickness and initial chloride content are exceedingly weak to the salinity balance based on two dimensions of the time and concentration.While the different FA texture and groundwater table not only affect the salinity equilibrium process of the whole reclaimed soil profile,but also change its balance state.Generally,coarse FA particles and high groundwater table can defer the salinity balance process of the reclaimed soil solution,and they also increase the chloride concentration of FA layer solutions,and even topsoil ones.

  16. VitruCare: Using digital health to overcome the bounded willpower of patients with long term conditions

    Directory of Open Access Journals (Sweden)

    Carolyn Louise Wilson

    2015-09-01

    Full Text Available Background: Long term conditions affect 40% of the UK population whilst utilising 70% of the health and social care funding. Digital health has emerged as a solution, to aid patients in self-managing their health and alter unhealthy behaviours. However, for digital health to be effective, the field must have an understanding of what hinders or motivates patient behaviour change. Behavioural economics, as a combination of psychology and economics, can provide this knowledge with relevant concepts, biases and heuristics. One such concept is bounded willpower, which explains why people struggle to make decisions based on their long term interests but are more susceptible to short-term benefits or costs. Aims: The aim of this research is to explore the concept of bounded willpower in relation to digital health within the UK. The focus is primarily on the product VitruCare and its effectiveness at overcoming the bounded willpower of patients with long term conditions. Method: VitruCare used feedback, commitment contracts and channel factors to help overcome bounded willpower in an intervention on 144 patients in the Bradford region who were suffering from hypertension. Quantitative variables of patients’ weight, blood pressure, GP attendances, A&E attendances, acute admissions and outpatient visits were recorded before and after usage. A paired samples t-test was used to indicate significant differences in these two conditions. Results: Results indicated significant improvements in weight (t = 7.377, p = 0.000, systolic (t = 6.743, p = 0.000 and diastolic (t = 11.936, p = 0.000 blood pressure, alongside a significant reduction in GP practice visits (t = 12.643, p = 0.000 and outpatient visits (t = 5.951, p = 0.000. There were no significant differences in A&E attendances (t = 1.440, p = 0.152 and acute admissions (t = 1.029, p = 0.305. Conclusions: VitruCare's understanding of behavioural economics and the potential psychological pitfalls in the

  17. Enzyme Immobilization Strategies and Electropolymerization Conditions to Control Sensitivity and Selectivity Parameters of a Polymer-Enzyme Composite Glucose Biosensor

    Directory of Open Access Journals (Sweden)

    Sharon A. Rothwell

    2010-06-01

    Full Text Available In an ongoing programme to develop characterization strategies relevant to biosensors for in-vivo monitoring, glucose biosensors were fabricated by immobilizing the enzyme glucose oxidase (GOx on 125 µm diameter Pt cylinder wire electrodes (PtC, using three different methods: before, after or during the amperometric electrosynthesis of poly(ortho-phenylenediamine, PoPD, which also served as a permselective membrane. These electrodes were calibrated with H2O2 (the biosensor enzyme signal molecule, glucose, and the archetypal interference compound ascorbic acid (AA to determine the relevant polymer permeabilities and the apparent Michaelis-Menten parameters for glucose. A number of selectivity parameters were used to identify the most successful design in terms of the balance between substrate sensitivity and interference blocking. For biosensors electrosynthesized in neutral buffer under the present conditions, entrapment of the GOx within the PoPD layer produced the design (PtC/PoPD-GOx with the highest linear sensitivity to glucose (5.0 ± 0.4 μA cm−2 mM−1, good linear range (KM = 16 ± 2 mM and response time (< 2 s, and the greatest AA blocking (99.8% for 1 mM AA. Further optimization showed that fabrication of PtC/PoPD-GOx in the absence of added background electrolyte (i.e., electropolymerization in unbuffered enzyme-monomer solution enhanced glucose selectivity 3-fold for this one-pot fabrication protocol which provided AA-rejection levels at least equal to recent multi-step polymer bilayer biosensor designs. Interestingly, the presence of enzyme protein in the polymer layer had opposite effects on permselectivity for low and high concentrations of AA, emphasizing the value of studying the concentration dependence of interference effects which is rarely reported in the literature.

  18. iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions

    OpenAIRE

    Parmanto, Bambang; Pramana, Gede; Yu, Daihua Xie; Fairman, Andrea D.; Dicianno, Brad E.; McCue, Michael P

    2013-01-01

    Background Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh...

  19. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care

    Directory of Open Access Journals (Sweden)

    Cherrington Andrea

    2011-03-01

    Full Text Available Abstract Background The risk of depression is increased in people with long term conditions (LTCs and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD. Methods Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29. One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14. Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Results Barriers to detecting and managing depression in people with LTCs in primary care exist: i when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Conclusion Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in

  20. Job mobility among parents of children with chronic health conditions: Early effects of the 2010 Affordable Care Act.

    Science.gov (United States)

    Chatterji, Pinka; Brandon, Peter; Markowitz, Sara

    2016-07-01

    We examine the effects of the 2010 Patient Protection and Affordable Care Act's (ACA) prohibition of preexisting conditions exclusions for children on job mobility among parents. We use a difference-in-difference approach, comparing pre-post policy changes in job mobility among privately-insured parents of children with chronic health conditions vs. privately-insured parents of healthy children. Data come from the 2004 and 2008 Survey of Income and Program Participation (SIPP). Among married fathers, the policy change is associated with about a 0.7 percentage point, or 35 percent increase, in the likelihood of leaving an employer voluntarily. We find no evidence that the policy change affected job mobility among married and unmarried mothers. PMID:27060524

  1. Antibiotic sensitivity and resistance pattern for neonatal sepsis in Klebsiella and Pseudomonas isolated pathogens in neonatal intensive care unit at tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Preeti Mallikarjunappa Dharapur

    2016-10-01

    Conclusions: The results obtained from this study done to evaluate the pattern of antibiotic sensitivity and resistance for neonatal sepsis in klebsiella and pseudomonas isolated pathogens showed that Meropenem as highly sensitive antibiotic and Amoxicillin as highly resistant antibiotic, hence they must be judiciously used to minimize the morbidity and mortality and also to reduce the emergence of multidrug resistant organisms in NICU. [Int J Basic Clin Pharmacol 2016; 5(5.000: 2110-2113

  2. Primary health care nurses’ management practices of common mental health conditions in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Faith N. Dube

    2015-02-01

    Full Text Available Background: Psychiatric conditions contribute to 13%of the global burden of diseases and account for one third of years lost because of disability (YLD. Despite the high prevalence of mental health problems, primary health care (PHC services remain ineffective in managing patients with mental health conditions.Objectives: The aim of the study was to determine the practices of PHC nurses in the management of psychiatric patients in primary health care clinics in one of the rural districts in South Africa.Method: A survey was conducted amongst nurses working in several PHC clinics in KwaZulu-Natal (KZN in order to determine their practices in the management of psychiatric patients. Mixed methods were used to determine the PHC nurses practices in the management of psychiatric patients.Results: The findings revealed that in five sites (83.3% treatments are not reviewed every six months, there were no local protocols on the administration of psychiatric emergency drugs, and none of the study sites provided psychiatric patients with education on their medication and its possible side effects.Conclusion: Based on the results of this study it is evident that psychiatric patients at PHC clinics in the district where the study was conducted do not receive quality treatment according to institutional mental health guidelines.

  3. Visual acuity of fly photoreceptors in natural conditions - dependence on UV sensitizing pigment and light-controlling pupil

    NARCIS (Netherlands)

    Stavenga, DG

    2004-01-01

    The effect of the UV-absorbing sensitizing pigment fly photoreceptors on absolute, spectral and angular sensitivity was investigated with a wave-optics model for the facet lens-rhabdomere system. When sky light was used as a UV-rich light source, one sensitizing pigment molecule per rhodopsin increa

  4. Comparison between superficial and solid-state cultures of Isaria fumosorosea: conidial yields, quality and sensitivity to oxidant conditions.

    Science.gov (United States)

    Muñiz-Paredes, Facundo; Garza-López, Paul Misael; Viniegra-González, Gustavo; Loera, Octavio

    2016-07-01

    Conidia production and quality from mycoinsecticides in solid-state cultures (SSC) are frequently inferred from superficial culture (SC) results. Both parameters were evaluated for two Isaria fumosorosea strains (ARSEF 3302 and CNRCB1), in SC and SSC, using culture media with the same chemical composition. For both strains, conidia production was higher in SC than SSC in terms of conidia per gram of dry substrate. Germination in both strains did not show significant differences between SC and SSC (>90 %). Similarly, conidia viability in ARSEF 3302 strain did not show differences at early stages between SC and SSC, but was higher in SC compared to SSC in the late stage of culture; in contrast, conidia from CNRCB1 strain did not differ between both culture systems. Some infectivity parameters improved in conidia from SSC, compared to SC at the early stages, but these differences disappeared at the final stage, independently of the strain. Both strains showed decreased conidia production when 26 % O2 pulses were applied; nevertheless, conidiation in SSC was two orders of magnitude more sensitive to oxidant pulses. In SC with 26 % O2 pulses, conidia viability for both strains at early stages, was higher than in normal atmospheric conditions. Infectivity towards Galleria mellonella larvae was similar between conidia from normal atmosphere and oxidant conditions; notably, for the strain ARSEF 3302 infectivity decreased at the final stage. This study shows the intrinsic differences between SC and SSC, which should be considered when using SC as a model to design production processes in SSC. PMID:27263006

  5. Primary care incidence and treatment of four neuropathic pain conditions: A descriptive study, 2002–2005

    Directory of Open Access Journals (Sweden)

    Carroll Dawn

    2008-05-01

    Full Text Available Abstract Background Between 1992 and 2001 the UK general practice incidence of post-herpetic neuralgia and trigeminal neuralgia declined, whilst the incidence of painful diabetic neuropathy increased. The most common first line treatments were compound analgesics. As therapeutic options have subsequently changed, this study presents updated data on incidence and prescribing patterns in neuropathic pain. Methods A descriptive analysis of the epidemiology and prescription treatment at diagnosis of incident post-herpetic neuralgia (n = 1,923; trigeminal neuralgia (1,862; phantom limb pain (57 and painful diabetic neuropathy (1,444 using computerised UK general practice records (THIN: May 2002 to July 2005. Results Primary care incidences per 100,000 person years observation of 28 (95% confidence interval (CI 27–30 for post-herpetic neuralgia, 27 (95%CI 26–29 for trigeminal neuralgia, 0.8 (95%CI 0.6–1.1 for phantom limb pain and 21 (95%CI 20–22 for painful diabetic neuropathy are reported. The most common initial treatments were tricyclic antidepressants (post-herpetic neuralgia or antiepileptics (trigeminal neuralgia and painful diabetic neuropathy and opioid analgesics (phantom limb pain. The mean number of changes before a stable drug regimen was 1.2 to 1.5 for trigeminal neuralgia, painful diabetic neuropathy and post-herpetic neuralgia, and 2.4 for phantom limb pain. Conclusion The incidence of phantom limb pain and post-herpetic neuralgia are decreasing whilst painful diabetic neuropathy plateaued and trigeminal neuralgia remained constant. Despite more frequent use of antidepressants and antiepileptics for first line treatment, as opposed to conventional non-opioid analgesics, changes to therapy are common before a stable regimen is reached.

  6. Burnout: Interpreting the perception of Iranian primary rural health care providers from working and organizational conditions

    Directory of Open Access Journals (Sweden)

    Mahrokh Keshvari

    2012-01-01

    Results: During the content analysis process, six themes were obtained; "instability and frequent changes", "involved in laws and regulations", "pressure and stress due to unbalanced workload and manpower", "helplessness in performing the tasks and duties", "sense of identity threat and low self-concept", and "deprivation of professional development". The mentioned themes indicate a main and more important theme called "burnout". Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community.

  7. conditions

    Directory of Open Access Journals (Sweden)

    M. Venkatesulu

    1996-01-01

    Full Text Available Solutions of initial value problems associated with a pair of ordinary differential systems (L1,L2 defined on two adjacent intervals I1 and I2 and satisfying certain interface-spatial conditions at the common end (interface point are studied.

  8. Myocardial performance index is sensitive to changes in cardiac contractility, but is also affected by vascular load condition.

    Science.gov (United States)

    Uemura, Kazunori; Kawada, Toru; Zheng, Can; Li, Meihua; Shishido, Toshiaki; Sugimachi, Masaru

    2013-01-01

    Myocardial performance index (MPI), or Tei index, is measured by Doppler echocardiography in clinical practice. MPI has been shown to be useful in evaluating left ventricular (LV) performance and predicting prognosis in cardiac patients. However, the effects of LV load and contractile states on MPI remain to be thoroughly investigated. In 14 anesthetized dogs, we obtained LV pressure-volume relationship with use of sonomicrometry and catheter-tip manometry. MPI was determined from the time derivative of LV volume and pressure. LV end-systolic pressure-volume ratio (Ees'), effective arterial elastance (Ea) and LV end-diastolic volume (Ved) were used as indices of LV contractility, afterload and preload, respectively. Hemodynamic conditions were varied over wide ranges [heart rate (HR), 66-192 bpm; mean arterial pressure, 71-177 mmHg] by infusing cardiovascular agents, by inducing ischemic heart failure and by electrical atrial pacing. Multiple linear regression analysis of pooled data (66 data sets) indicated that MPI (0.6-1.8) significantly correlated with Ees' [1.5-17.5 mmHg · ml(-1), pVed (11-100 ml, p0.1). Theoretical analysis also indicated that MPI decreases following the increases in LV contractility and in preload, while it increases in response to an increase in LV afterload. We conclude that MPI sensitively detects changes in LV contractility. However, MPI is also affected by changes in LV afterload and preload. PMID:24109782

  9. Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark:

    DEFF Research Database (Denmark)

    Davydow, Dimitry; Ribe, Anette Riisgaard; Pedersen, Henrik Søndergaard;

    2015-01-01

    Antallet af akutte indlæggelser for kroniske sygdomme har i de senere år været stigende i den vestlige verden. De mange indlæggelser har medført øgede udgifter i sundhedsvæsenet, selvom nogle af disse indlæggelser potentielt kunne være undgået med forebyggelse og behandling i det nære sundhedsvæs...

  10. Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.

    Directory of Open Access Journals (Sweden)

    Ye Xu

    Full Text Available Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR, and failure-to-rescue rate (RS-FTR. The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.We found good overall quality with large variations by hospital and condition (mean/range, in %: RSMR-AMI: 6.23 (2.37-14.48, RSMR-stroke: 4.18 (3.58-4.44, RSMR-pneumonia: 7.78 (7.20-8.59, RSMR-CABG: 1.93 (1.55-2.23, RS-CR: 11.38 (9.9-12.88, and RS-FTR: 6.41 (5.17-7.58. Hospital grade was not significantly associated with any risk-adjusted outcome measures.Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.

  11. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India

    Directory of Open Access Journals (Sweden)

    Nutanbala N Goswami

    2011-01-01

    Full Text Available Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85% isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%, was the predominant organism. S. aureus was sensitive to rifampicin (89.58%, levofloxacin (60.42%, and vancomycin (54.17%. Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%, gatifloxacin (51.35%, and meropenem (51.35%. Escherichia coli was sensitive to levofloxacin (72.41% and ciprofloxacin (62.07%. Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%, levofloxacin (63.16%, gatifloxacin (63.16%, and linezolid (56.52%. Proteus mirabilis was sensitive to ciprofloxacin (75% and linezolid (62.50. Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14% followed by levofloxacin (50%. Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

  12. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care

    Directory of Open Access Journals (Sweden)

    Reach G

    2016-04-01

    Full Text Available Gérard Reach1,2 1Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 2EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: Patient education (PE is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient’s personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment. This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient–doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care. Keywords: patient education, adherence, autonomy, nudge, persuasion, manipulation, deception, trust, person-centered care model, shared decision-making

  13. Chromosomal Conditions

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Ask ...

  14. Two-warehouse inventory model for deteriorating items with price-sensitive demand and partially backlogged shortages under inflationary conditions

    Directory of Open Access Journals (Sweden)

    Chandra K. Jaggi

    2015-01-01

    Full Text Available In today’s competition inherited business world, managing inventory of goods is a major challenge in all the sectors of economy. The demand of an item plays a significant role while managing the stock of goods, as it may depend on several factors viz., inflation, selling price, advertisement, etc. Among these, selling price of an item is a decisive factor for the organization; because in this competitive world of business one is constantly on the lookout for the ways to beat the competition. It is a well-known accepted fact that keeping a reasonable price helps in attracting more customers, which in turn increases the aggregate demand. Thus in order to improve efficiency of business performance organization needs to stock a higher inventory, which needs an additional storage space. Moreover, in today’s unstable global economy there is consequent decline in the real value of money, because the general level of prices of goods and services is rising (i.e., inflation. And since inventories represent a considerable investment for every organization, it is inevitable to consider the effects of inflation and time value of money while determining the optimal inventory policy. With this motivation, this paper is aimed at developing a two-warehouse inventory model for deteriorating items where the demand rate is a decreasing function of the selling price under inflationary conditions. In addition, shortages are allowed and partially backlogged, and the backlogging rate has been considered as an exponentially decreasing function of the waiting time. The model jointly optimizes the initial inventory and the price for the product, so as to maximize the total average profit. Finally, the model is analysed and validated with the help of numerical examples, and a comprehensive sensitivity analysis has been performed which provides some important managerial implications.

  15. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity

    Directory of Open Access Journals (Sweden)

    Esposito Pasquale

    2011-03-01

    Full Text Available Abstract Background Celiac disease (CD is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders. Methods CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity. Results Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308, paralleled by significantly increased expression of claudin (CLDN 4 (P = 0.0286. Relative to controls, adaptive immunity markers interleukin (IL-6 (P = 0.0124 and IL-21 (P = 0.0572 were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR 2 was increased in GS but not in CD (P = 0.0295. Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325 and CD patients (P = 0.0293. Conclusions This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.

  16. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Goel Nidhi

    2009-01-01

    Full Text Available Background: Lower respiratory tract infections (LRTIs are the most frequent infections among patients in Intensive care units (ICUs. Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI. Results: Of 207 specimens, 144 (69.5% were culture positive and 63 (30.4% showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6% were Gram negative bacilli (GNB. In 17 (11.0% patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%, Acinetobacter baumannii (23.6%, and Klebsiella pneumoniae (13.6%. A very high rate of resistance (80-100% was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

  17. Life history trade-offs and behavioral sensitivity to testosterone: an experimental test when female aggression and maternal care co-occur.

    Directory of Open Access Journals (Sweden)

    Kimberly A Rosvall

    Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.

  18. Attitudes of livestock farmers and sensitivity of livestock farming systems to drought conditions in the French Alps

    Directory of Open Access Journals (Sweden)

    Laurent Dobremez

    2011-01-01

    Full Text Available Livestock farming systems in the French Alps are particularly exposed to the predicted climate change and most of them have already experienced periods of drought since the beginning of the 2000s. Faced with this risk, livestock farmers have put in place a certain number of measures and envisage introducing others in the future. For the present study, surveys were conducted among livestock farmers to identify these measures and analyses were carried out to characterise the attitudes of livestock farmers to drought conditions and to evaluate changes in the sensitivity of their livestock farming systems. With the exception of those farms with extensive irrigated areas, all the farms are seeking solutions to deal with the risks arising from droughts. One solution is to purchase fodder to compensate for the decrease in the harvests that normally provide animal feed in the winter; the amounts purchased vary with the length of wintering required. For the grazing periods, the high mountain livestock breeders and the dairy systems of the Northern Alps rely above all on extending and over-sizing the pasture areas in relation to the needs of the herds. The livestock farms of the Southern Alps also rely on the diversity of vegetation areas and a certain flexibility in the practices used to adapt to conditions experienced during the year. A succession of dry years could result in more radical breakdowns in the livestock systems. It should also be remembered that climate change is only one of the factors influencing the types of changes taking place on farms.Les systèmes d'élevage des Alpes françaises sont fortement exposés au changement climatique annoncé et la plupart subissent déjà des épisodes de sécheresse depuis le début des années 2000. Face à ces aléas, les éleveurs ont mis en œuvre un certain nombre de leviers et envisagent d'en activer d'autres à l'avenir. Des enquêtes en exploitation ont permis d’identifier ces leviers. Leur

  19. Teams and working conditions in mobile pre-hospital care services: an integrative review

    Directory of Open Access Journals (Sweden)

    Daiane Dal Pai

    2015-12-01

    Full Text Available Study to identify, analyze and summarize the findings available in the literature on the composition of teams and working conditions in Mobile  Pre-Hospital Care Services  (PHC.  Integrative review to search the Base  de Dados  de  Enfermagem [Nursing Database] (BDEnf, the Cumulative  Index  to  Nursing  and  Allied  Health  Literature (CINAHL,  the Latin American and Caribbean Health Sciences Literature (LILACS, PubMed,  SCOPUS,  Web  of  Science and the portal of journals from the Scientific  Electronic  Library Online  (SciELO. Eighteen articles met the inclusion criteria and were selected. The composition of the teams for PHC services is diversified on the international stage, with the increase in responsibilities assumed by paramedics and the benefits of the specialized nurse's and doctor's presence in the teams being portrayed, which are scarce in some countries.  Working conditions reveal risky places of work, intense psychological demands, work overload, dissatisfaction and inadequate resources in most services.

  20. Evaluation of the strengthening of the conditions of voltage security using sensitivity analysis; Avaliacao do reforco das condicoes da seguranca de tensao utilizando a analise de sensibilidade

    Energy Technology Data Exchange (ETDEWEB)

    Rosa, A.L.S.; Costa, V.M. da; Peres, W. [Universidade Federal de Juiz de Fora (UFJF), MG (Brazil). Faculdade de Engenharia], Emails: arleilucas@gmail.com, vander@lacee.ufjf.br, wesley.peres@yahoo.com.br; Prada, R.B. [Pontificia Universidade Catolica (PUC-Rio), Rio de Janeiro, RJ (Brazil). Dept. de Engenharia Eletrica], Email: prada@ele.puc-rio.br

    2009-07-01

    Voltage stability or voltage security analysis has motivated an expressive attention of power systems researchers. In this work, a simple and fast method evaluates voltage security and proposes conditions to improve the loading margin. System analysis is carried out in terms of active power transmission path. Sensitivity analysis provides the most adequate buses to active and reactive power redispatch. A sequential iterative methodology to reinforce system conditions is presented. (author)

  1. Investigating and Addressing Barriers to the Effective Recognition and Management of Depression in People with Long-term Conditions in Primary Care

    OpenAIRE

    Karachaliou, Dimitra

    2016-01-01

    Objectives: Depression is often unrecognised or sub-optimally treated in primary care. This has led to research exploring the barriers and enablers to effective recognition but little is known about health care professionals’ (HCPs) beliefs or personal illness models about depression in patients with long term conditions (LTCs), the presence of which may affect recognition and management. Using Leventhal’s Common Sense or Self-regulatory Model this thesis aimed to: explore HCPs’ illness repre...

  2. CURRENT SENSITIVITY PATTERN OF MRSA (METHICILLIN RESISTANT STAPH AUREUS IN A TERTIARY CARE ORTHOPAEDIC HOSPITAL IN KASHMIR (J&K

    Directory of Open Access Journals (Sweden)

    Shaika

    2016-02-01

    Full Text Available In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52% samples grew no organisms while Staph aureus was grown in 43 samples (26.8% and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4% and MSSA in 11 (25.6%. These belonged to 23 (71.8% males and 9 (28.1% females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%. Linezolid showed highest sensitivity (100% followed by Vancomycin (96.8%, Clindamycin (37.5%, erythromycin (21%, Amikacin (21%, Levofloxacin (9.3%, cotrimoxazole (9.3% and ciprofloxacin (3.1%. By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%. However, on further analysis using MIC only one isolate (3.3% showed intermediate resistance to vancomycin; 12 cultures (37.5% were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem.

  3. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources...... are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...

  4. Garde a l'enfance: Etude sur la remuneration et les conditions de travail dans le domaine de la garde a l'enfance au Canada. Rapport final (Caring for a Living: A Study on Wages and Working Conditions in Canadian Child Care. Final Report).

    Science.gov (United States)

    Canadian Child Care Federation, Ottawa (Ontario).

    Between November 1990 and August 1992, a study examined wages and working conditions of child care staff in both licensed group centers and family day care homes in Canada. Three instruments were developed for the study, a short telephone interview for center directors, a follow-up director's questionnaire, and a staff questionnaire. The study…

  5. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  6. Sensitivities of crop models to extreme weather conditions during flowering period demonstrated for maize and winter wheat in Austria

    DEFF Research Database (Denmark)

    Eitzinger, J; Thaler, S; Schmid, E;

    2013-01-01

    the start of flowering. Two locations in Austria, representing different agro-climatic zones and soil conditions, were included in the simulations over 2 years, 2003 and 2004, exhibiting contrasting weather conditions. In addition, soil management was modified at both sites by following either ploughing...

  7. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    OpenAIRE

    Latour Judith; Leduc Nicole; Leclerc Bernard-Simon; Kergoat Marie-Jeanne; Berg Katherine; Bolduc Aline

    2009-01-01

    Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 o...

  8. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

    OpenAIRE

    Reuven Rasooly; Hugh Alan Bruck; Joshua Balsam; Ben Prickril; Miguel Ossandon; Avraham Rasooly

    2016-01-01

    Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for u...

  9. Conditional Estimation of Sensitivity and Specificity from a Phase 2 Biomarker Study Allowing Early Termination for Futility

    OpenAIRE

    Pepe, Margaret Sullivan; Feng, Ziding; Longton, Gary; Koopmeiners, Joseph

    2009-01-01

    Development of a disease screening biomarker involves several phases. In phase 2 its sensitivity and specificity is compared with established thresholds for minimally acceptable performance. Since we anticipate that most candidate markers will not prove to be useful and availability of specimens and funding is limited, early termination of a study is appropriate if accumulating data indicate that the marker is inadequate. Yet, for markers that complete phase 2, we seek estimates of sensitivit...

  10. Evaluation of IGBT thermo-sensitive electrical parameters under different dissipation conditions – Comparison with infrared measurements

    OpenAIRE

    Avenas, Yvan; Dupont, Laurent

    2012-01-01

    Junction temperature evaluation is a key parameter used to control a power module assembly. But measuring the junction temperature by thermo-sensitive electrical parameters (TSEPs) does not reveal the actual temperature of the semiconductor device. In this paper, a specific electronic board used to compare four common TSEPs of IGBT chips is presented. For this comparison, two dissipation modes are used: dissipation in active and saturation regions. In order to have referential measurements we...

  11. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects.

    Science.gov (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera

    2016-07-15

    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits. PMID:27123670

  12. Study of Incidence, Risk Factors and Antibiotic Sensitivity Pattern of Acinetobacter baumannii in a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Vijaya S Rajmane

    2015-01-01

    Full Text Available Background: Recently, Acinetobacter species has emerged as an important pathogen and the prevalence of infection has increased since last two decades worldwide. Objective: To see the impact of Acinetobacter infection in our hospital and antibiotic sensitivity and resistance pattern. Material and Methods: The study was carried out on clinical samples submitted to the Microbiology laboratory in Krishna institute of Medical Sciences and Research, Karad, over a period of one year (July 2012 to June 2013.Various risk factors like length of hospital stay, ICU admission, any interventions done were noted. Identification and antibiotic susceptibility of the isolates was performed using standard protocol. Results: Out of a total 2728 samples, 86 (3.15% were found to be due to Acinetobacter baumannii. Of the 86 isolates the organism was predominantly isolated from pus samples 48 (55.81% followed by sputum 17 (19.76%, urine 6 (6.97% and blood 4 (4.65%. Out of 86 Acinetobacter isolates, 76 (88.37% showed resistance to Cephalexin, 74 (86.04% each to Cefotaxime and Ceftazidime. The isolates also showed high level of resistance to Ciprofloxacin (82.55%, Ampicillin (77.90% and Gentamicin (74.41%. The isolates from urine samples showed 100% sensitivity to Nitrofurantoin. Imipenem and Meropenem were highly active against the isolate with least resistance of 12.79% each. Conclusion: The present study highlights Acinetobacter species as an important pathogen because of multidrug resistant strains jerking in the hospital environment.

  13. Microorganisms and their sensitivity pattern in septic arthritis of north Indian children: a prospective study from tertiary care level hospital.

    Science.gov (United States)

    Yadav, Sanjay; Dhillon, Mandeep Singh; Aggrawal, Sameer; Tripathy, Sujit Kumar

    2013-01-01

    Background. Septic arthritis is a true orthopaedic emergency. Important factors determining outcome are rapid diagnosis and timely intervention. Changing trends in microbiological spectrum and emerging drug resistance poses big challenge. Present study evaluates bacterial strains and their sensitivity pattern in septic arthritis of North Indian children. Methods. Fifty children with septic arthritis of any joint were evaluated. Joint was aspirated and 2 cc of aspirated fluid was sent for gram stain and culture. Blood cultures were also sent for bacteriological evaluation. Results. Fifty percent cases had definite radiological evidence of septic arthritis whereas ultrasound revealed fluid in 98% cases. Aspirated fluid showed isolates in 72% cases. The most common organism was Staphylococcus aureus (62%) followed by Streptococcus pneumoniae and Gr. B Streptococcus. Blood culture could grow the organism in 34% cases only. The bacterial strain showed significant resistance to common antibiotic cocktail in routine practice. Resistance to cloxacillin and ceftriaxone was 62% and 14% respectively. No organisms were resistant to vancomycin and linezolid. Conclusion. S. aureus is still the most common organism in septic arthritis. Though a significant resistance to common antibiotic cocktail is noticed, the strain is susceptible to higher antibiotics. We recommend using these antibiotics as an empirical therapy till culture and sensitivity report is available. PMID:24967110

  14. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects.

    Science.gov (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera

    2016-07-15

    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits.

  15. [THE DEVELOPMENT OF MEDICAL CARE OF POPULATION IN CONDITIONS OF SPECIALIZED DAY-TIME HOSPITALS OF NEUROLOGICAL PROFILE].

    Science.gov (United States)

    Grishina, N K; Solovieva, N B; Abdulsalamova, Z A

    2015-01-01

    The article considers issues concerning increasing of quality and accessibility of medical care in Moscow neurological profile included at the expense of wide-spread implementation of specialized day-time hospitals in health care practice. The analysis applied was based on average Moscow indicators of functioning of public health institutions and characteristics of clinical course of diseases of the mentioned profile.

  16. Living in a country with a strong primary care system is beneficial to people with chronic conditions

    NARCIS (Netherlands)

    Hansen, Johan; Groenewegen, Peter P.; Boerma, Wienke G W; Kringos, Dionne S.

    2015-01-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  17. Living in a country with a strong primary care system is beneficial to people with chronic conditions.

    NARCIS (Netherlands)

    Hansen, J.; Groenewegen, P.P.; Boerma, W.G.W.; Kringos, D.S.

    2015-01-01

    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  18. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    Science.gov (United States)

    Montaldo, N.; Toninelli, V.; Albertson, J. D.; Mancini, M.; Troch, P. A.

    Recent developments have made land-surface models (LSMs) more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps), a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity) using the TOPLATS model, an existing LSM. In the summer and autumn of 1999, which included both wet (atmosphere controlled) and dry (soil controlled) periods, actual evapotranspiration estimates were performed using Bowen ratio and, for a short period, eddy correlation methods. Measurements performed with the two methods are in good agreement. The calibrated LSM predicts actual evapotranspiration quite well over the whole observation period. A sensitivity analysis of the evapotranspiration to model parameters was performed through the global multivariate technique during both wet and dry periods of the campaign. This approach studies the influence of each parameter without conditioning on certain values of the other variables. Hence, all parameters are varied simultaneously using, for instance, a uniform sampling strategy through a Monte Carlo simulation framework. The evapotranspiration is highly sensitive to the soil parameters, especially during wet periods. However, the evapotranspiration is also sensitive to some vegetation parameters and, during dry periods, wilting point is the most critical for evapotranspiration predictions. This result confirms the importance of correct representation of vegetation properties which, in water-limited conditions, control evapotranspiration.

  19. The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness.

    Directory of Open Access Journals (Sweden)

    Weng Yee Chin

    Full Text Available The Center for Epidemiologic Studies Depression Scale (CES-D is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9 and the Short Form-12 Health Survey (version 2 Mental Component Summary (SF-12 v2 MCS. The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78 and SF-12 v2 MCS (coefficient: -0.75. Internal consistency was assessed by McDonald's omega hierarchical (ωH. The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value 0.2. The CES-D was externally responsive, with the AUC>0.7.The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original

  20. Pedagogical Staff in Children's Day Care Centres in Germany--Links between Working Conditions, Job Satisfaction, Commitment and Work-Related Stress

    Science.gov (United States)

    Schreyer, Inge; Krause, Martin

    2016-01-01

    This article investigates links between staff working conditions in children's day care centres ("Kindertageseinrichtungen"--known as "Kitas" in Germany), job satisfaction, commitment and perceived stress at work. Data are based on the nationwide, representative questionnaire survey AQUA ("Arbeitsplatz und Qualität in…

  1. THERAPEUTIC PROCEDURES OF CHILDREN WITH DISHARMONIOUS DEVELOPMENT AT THE EARLY SCHOOL PERIOD IN CONDITIONS OF DAY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dragoslav KOPACEV

    1997-12-01

    Full Text Available The term disharmonious is determined against the harmonious development of children. It is stressed that these children, because of the whole bio-psycho-social growth which is at a lower level, very often react with psychical disorders, compared with the children which normally develop and this seems to be not only a serious problem in the diagnostics but also in the performing of the adequate and in due time treatment.Trained by the existing experiences in the work with these children it is indicated that the best differential-diagnostics is performed in conditions of Day hospital where a whole treatment is provided by a professional team. In the treatment in this category of children it is insisted on the respect of the developmental dynamic approach, and for this, the acknowledgments that are given by the neuropsychology are used. The need of early treatment of a child, parents and the closest environment is stressed because if these children are neglected, they show the tendency to organize themselves at their lowest values, they intellectually decline and lead to severe psycho social results .Working with these children in our Day care hospital although we use a great number of therapeutic activities, we put the stress on the application of psycho-motor re education. The use of remedial therapy is the only technical, without including the parents in the working plan, has shown as unadequate. Although there is an intellectual insufficiency, we tend these children to be mentally healthy, if we succeed to achieve bigger harmony in the function of the cognitive, emotional, motor and social aspects of the individual. Providing continuity in the treatment of this category of children, it is insisted to provide the preschool institutions with planned and professional team work. The stress is put on the defectological activity, in a way to prepare the children to enroll in school.

  2. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

    Directory of Open Access Journals (Sweden)

    Kapadia Dharmi

    2011-05-01

    Full Text Available Abstract Background Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Methods Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT, and the whole systems informing self-management engagement (WISE approach to self-care support. Discussion The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

  3. A comparison of how four countries use health IT to support care for people with chronic conditions.

    Science.gov (United States)

    Adler-Milstein, Julia; Sarma, Nandini; Woskie, Liana R; Jha, Ashish K

    2014-09-01

    Countries around the globe are investing in health information and communications technologies (ICTs) as critical tools for improving care for chronically ill patients. We profiled four high-income nations with varied health ICT strategies--Australia, Canada, Denmark, and the United States--to describe their use of ICTs to improve chronic care. Our goal was to identify common challenges and opportunities for cross-national learning. We found four key themes. First, although all four countries have a national strategy for health ICT adoption, strategies are implemented and adapted to chronic care needs regionally, which creates the challenge of spreading successful efforts across regions. Second, each country struggles with how to ensure that clinical information follows patients seamlessly between care settings. Third, although each nation is pursuing telehealth solutions as a component of chronic care, the telehealth initiatives are usually stand-alone efforts that are not well integrated into other ICT solutions, such as electronic health records. Finally, countries have made progress in improving patients' access to their clinical data but have not fully succeeded in engaging patients to apply the data to improve care. These common themes suggest that although the four nations have different health care systems and ICT strategies, all of them face a similar set of challenges, creating an opportunity for cross-national learning. PMID:25201660

  4. The sensitivity of Sphagnum to surface layer conditions in a re-wetted bog: a simulation study of water stress

    NARCIS (Netherlands)

    Schouwenaars, J.M.; Gosen, A.M.

    2007-01-01

    The behaviour of the water table in re-wetted bogs varies widely between different locations so that recolonising Sphagnum is vulnerable to water stress, especially when the water table is drawn down in summer. It is important to understand how physical site conditions influence the occurrence of wa

  5. Caring for Multiples

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... Home > Complications & Loss > The newborn intensive care unit (NICU) > Caring for multiples Caring for multiples E-mail ...

  6. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    Directory of Open Access Journals (Sweden)

    N. Montaldo

    2003-01-01

    Full Text Available Recent developments have made land-surface models (LSMs more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps, a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity using the TOPLATS model, an existing LSM. In the summer and autumn of 1999, which included both wet (atmosphere controlled and dry (soil controlled periods, actual evapotranspiration estimates were performed using Bowen ratio and, for a short period, eddy correlation methods. Measurements performed with the two methods are in good agreement. The calibrated LSM predicts actual evapotranspiration quite well over the whole observation period. A sensitivity analysis of the evapotranspiration to model parameters was performed through the global multivariate technique during both wet and dry periods of the campaign. This approach studies the influence of each parameter without conditioning on certain values of the other variables. Hence, all parameters are varied simultaneously using, for instance, a uniform sampling strategy through a Monte Carlo simulation framework. The evapotranspiration is highly sensitive to the soil parameters, especially during wet periods. However, the evapotranspiration is also sensitive to some vegetation parameters and, during dry periods, wilting point is the most critical for evapotranspiration predictions. This result confirms the importance of correct representation of vegetation properties which, in water-limited conditions, control evapotranspiration. Keywords: evapotranspiration, sensitivity analysis, land surface model, eddy correlation, Alpine basin

  7. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

    Directory of Open Access Journals (Sweden)

    Rick Jo

    2012-08-01

    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  8. The sensitivity of the Late Saalian (140 ka) and LGM (21 ka) Eurasian ice sheets to sea surface conditions

    Energy Technology Data Exchange (ETDEWEB)

    Colleoni, Florence [Centro Euro-Mediterraneo per i Cambiamenti Climatici, Bologna (Italy); UJF, CNRS, Laboratoire de Glaciologie et Geophysique de l' Environnement, Saint Martin d' Heres Cedex (France); Stockholm University, Department of Geological Sciences, Stockhlom (Sweden); Liakka, Johan [Stockholm University, Department of Meteorology, Stockholm (Sweden); Krinner, Gerhard; Peyaud, Vincent [UJF, CNRS, Laboratoire de Glaciologie et Geophysique de l' Environnement, Saint Martin d' Heres Cedex (France); Jakobsson, Martin [Stockholm University, Department of Geological Sciences, Stockhlom (Sweden); Masina, Simona [Centro Euro-Mediterraneo per i Cambiamenti Climatici, Istituto Nazionale di Geofisica e Vulcanologia, Bologna (Italy)

    2011-08-15

    This work focuses on the Late Saalian (140 ka) Eurasian ice sheets' surface mass balance (SMB) sensitivity to changes in sea surface temperatures (SST). An Atmospheric General Circulation Model (AGCM), forced with two preexisting Last Glacial Maximum (LGM, 21 ka) SST reconstructions, is used to compute climate at 140 and 21 ka (reference glaciation). Contrary to the LGM, the ablation almost stopped at 140 ka due to the climatic cooling effect from the large ice sheet topography. Late Saalian SST are simulated using an AGCM coupled with a mixed layer ocean. Compared to the LGM, these 140 ka SST show an inter-hemispheric asymmetry caused by the larger ice-albedo feedback, cooling climate. The resulting Late Saalian ice sheet SMB is smaller due to the extensive simulated sea ice reducing the precipitation. In conclusion, SST are important for the stability and growth of the Late Saalian Eurasian ice sheet. (orig.)

  9. Job load and hazard analysis: a method for the analysis of workplace conditions for occupational health care.

    OpenAIRE

    Mattila, M K

    1985-01-01

    One requirement for successful occupational health care is reliable information on occupational hazards. The aim of this study was to develop a simple, standardised method for workplace investigations for use in occupational health care. The theoretical framework of the method comprises the stress-strain model, the hazard-danger model, and risk behaviour theory. The new method, termed job load and hazard analysis, includes four stages: identification of hazards, their evaluation, conclusions ...

  10. Application of the statistical safety evaluation method to the small break LOCA with high pressure injection failure. Sensitivity analyses to determine the break conditions

    International Nuclear Information System (INIS)

    By applying a statistical safety evaluation method, the uncertainties of best estimate results can be estimated quantitatively, and as a consequence, excessive conservatism can be reasonably removed to obtain evaluation results with enhanced reliability. Application of a statistical evaluation method is being made to analyses of the “low pressure injection by intentional depressurization of the steam generator secondary side” which is an accident management approach in a SBLOCA (small break loss-of-coolant accident) with HPI (high pressure injection) failure. At the time of a SBLOCA, the break conditions such as the break size are important parameters since they influence PCT (peak cladding temperature). In this research, sensitivity analyses about the break size, direction and position were carried out for a system plant under a condition which the start timing of the steam generator secondary side intentional depressurization is severer than an actual abnormal operating condition. From the result of the sensitivity analyses, differences in the phenomena progression which change depending on the break conditions were evaluated, and a 3 inch facing-down break of the cold-leg was determined as the base case of a statistical safety evaluation. (author)

  11. Assessing the sensitivity of Melanoplus frigidus (Orthoptera:Acrididae) to different weather conditions: A modeling approach focussing on development times

    Institute of Scientific and Technical Information of China (English)

    Oliver-D. Finch; J(o)rg L(o)ffler; Roland Pape

    2008-01-01

    The temperature and soil moisture conditions as well as vegetation patterns were studied to describe the habitat and to model the life cycle of Melanoplusfrigidus, a true alpine grasshopper of the Scandes. In the low alpine belt of the Norwegian Scandes the species colonizes only the warmest microhabitats with maximum soil surface temperatures of 31℃. Vegetation of these habitats consists of shrub-rich heath dominated by Vaccinium myrtillus and Calluna vulgaris. Using continuously measured temperature data, the development times for four different seasons were modeled and related to field observations. The maximum delay of adult molt was estimated to amount to 3 weeks, the delay being determined by the variation in spring temperature conditions between different years. The possibilities of using M. frigidus as an indicator organism of climate change effects on alpine zoo-coenoses of the Scandes are discussed.

  12. Stress-induced enhancement of fear conditioning and sensitization facilitates extinction-resistant and habituation-resistant fear behaviors in a novel animal model of posttraumatic stress disorder.

    Science.gov (United States)

    Corley, Michael J; Caruso, Michael J; Takahashi, Lorey K

    2012-01-18

    Posttraumatic stress disorder (PTSD) is characterized by stress-induced symptoms including exaggerated fear memories, hypervigilance and hyperarousal. However, we are unaware of an animal model that investigates these hallmarks of PTSD especially in relation to fear extinction and habituation. Therefore, to develop a valid animal model of PTSD, we exposed rats to different intensities of footshock stress to determine their effects on either auditory predator odor fear extinction or habituation of fear sensitization. In Experiment 1, rats were exposed to acute footshock stress (no shock control, 0.4 mA, or 0.8 mA) immediately prior to auditory fear conditioning training involving the pairing of auditory clicks with a cloth containing cat odor. When presented to the conditioned auditory clicks in the next 5 days of extinction testing conducted in a runway apparatus with a hide box, rats in the two shock groups engaged in higher levels of freezing and head out vigilance-like behavior from the hide box than the no shock control group. This increase in fear behavior during extinction testing was likely due to auditory activation of the conditioned fear state because Experiment 2 demonstrated that conditioned fear behavior was not broadly increased in the absence of the conditioned auditory stimulus. Experiment 3 was then conducted to determine whether acute exposure to stress induces a habituation resistant sensitized fear state. We found that rats exposed to 0.8 mA footshock stress and subsequently tested for 5 days in the runway hide box apparatus with presentations of nonassociative auditory clicks exhibited high initial levels of freezing, followed by head out behavior and culminating in the occurrence of locomotor hyperactivity. In addition, Experiment 4 indicated that without delivery of nonassociative auditory clicks, 0.8 mA footshock stressed rats did not exhibit robust increases in sensitized freezing and locomotor hyperactivity, albeit head out vigilance

  13. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Jaydip Ray Chaudhuri

    2013-07-01

    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  14. The sensitivity of Sphagnum to surface layer conditions in a re-wetted bog: a simulation study of water stress

    Directory of Open Access Journals (Sweden)

    J.M. Schouwenaars

    2007-04-01

    Full Text Available The behaviour of the water table in re-wetted bogs varies widely between different locations so that recolonising Sphagnum is vulnerable to water stress, especially when the water table is drawn down in summer. It is important to understand how physical site conditions influence the occurrence of water stress so that adequate management measures may be applied. In the work reported here, the respective roles of the hydrophysical properties of the uppermost peat layer and micro-scale site conditions are investigated using a Soil-Water-Atmosphere-Plant (SWAP model, which simulates water table fluctuations and soil moisture conditions. The variables are: (a cover and thickness of the Sphagnum layer, (b microtopography (presence of open water, (c hydrophysical properties of the uppermost soil layer and (d rate of downward seepage. Data for the model are derived from field observations, from published literature, and from laboratory determinations of moisture characteristic curves and saturated and unsaturated hydraulic conductivity (k–h–Θ relationships for peat. The simulation indicates that microtopography and the thickness of the moss layer are the dominant factors affecting groundwater behaviour and the risk of water stress. Sphagnum layers a few centimetres thick should be relatively well supplied with water from the underlying peat but as the Sphagnum carpet thickens, water movement through the unsaturated zone to the growing capitula will become increasingly difficult. Sphagnum layers appear to be most vulnerable to water stress when they are 5–15 cm thick. Beyond this thickness, water stored within the Sphagnum layer itself begins to offset the decline in the flux from below, and thus to reduce the dependence of the water supply to the stem tips on the maintenance of hydraulic continuity with the water table. The results obtained using the model underline the close interdependence between Sphagnum development and the accompanying

  15. Identifying the key elements of an education package to up-skill multidisciplinary adult specialist palliative care teams caring for young adults with life-limiting conditions: an online Delphi study

    Science.gov (United States)

    Sivell, Stephanie; Lidstone, Victoria; Taubert, Mark; Thompson, Catherine; Nelson, Annmarie

    2015-01-01

    Objectives To collect the views of experts to inform the development of an education package for multidisciplinary adult specialist palliative care (SPC) teams caring for young people with life-limiting conditions. Methods A modified online Delphi process collated expert opinion on format, delivery and content of an education package to up-skill adult SPC teams. Round 1 participants (n=44) answered free-text questions, generating items for Round 2. In Round 2, 68 participants rated the extent to which they agreed/disagreed with the items on 5-point Likert-type scales. Median and mean scores assessed the importance of each item. IQR scores assessed level of consensus for each item; items lacking consensus were rerated by 35 participants in Round 3. Results In the Delphi, consensus was reached on a range of suggested formats, on who should deliver the training, and on several clinical, psychosocial and practical topics. Conclusions Development of a continuous/rolling programme of education, tailored for content and mode of delivery and incorporated into working practice is recommended. As a direct outcome of the results of this study, a series of six linked study days has been established, focusing specifically on the issues around caring for young adults with life-limiting conditions and palliative care needs. PMID:24670554

  16. The Effect of UV-Irradiation (under Short-Circuit Condition on Dye-Sensitized Solar Cells Sensitized with a Ru-Complex Dye Functionalized with a (diphenylaminoStyryl-Thiophen Group

    Directory of Open Access Journals (Sweden)

    Kazuteru Nonomura

    2009-01-01

    Full Text Available A new ruthenium complex, cis-di(thiocyanato(2,2′-bipyridine-4,4′-dicarboxylic acid(4,4′-bis(2-(5-(2-(4-diphenylaminophenylethenyl-thiophen-2-ylethenyl-2,2′-bipyridineruthenium(II (named E322 has been synthesized for use in dye-sensitized solar cells (DSCs. Higher extinction coefficient and a broader absorption compared to the standard Ru-dye, N719, were aimed. DSCs were fabricated with E322, and the efficiency was 0.12% initially. (4.06% for N719, as reference. The efficiency was enhanced to 1.83% by exposing the cell under simulated sunlight containing UV-irradiation at short-circuit condition. The reasons of this enhancement are (1 enhanceing electron injection from sensitizer to TiO2 following a shift toward positive potentials of the conduction band of TiO2 by the adsorption of protons or cations from the sensitizer, or from the redox electrolyte and (2 improving the regeneration reaction of the oxidized dye by the redox electrolyte by the dissolution of aggregated dye from the surface of TiO2 following the treatment.

  17. RNA profiles of porcine embryos during genome activation reveal complex metabolic switch sensitive to in vitro conditions

    DEFF Research Database (Denmark)

    Østrup, Olga; Olbricht, Gayla; Østrup, Esben;

    2013-01-01

    stage) EGA and determine major metabolic changes that regulate totipotency. The period before EGA was dominated by transcripts responsible for cell cycle regulation, mitosis, RNA translation and processing (including ribosomal machinery), protein catabolism, and chromatin remodelling. Following EGA...... an increase in the abundance of transcripts involved in transcription, translation, DNA metabolism, histone and chromatin modification, as well as protein catabolism was detected. The further analysis of members of overlapping GO terms revealed that despite that comparable cellular processes are taking place...... before and after EGA (RNA splicing, protein catabolism), different metabolic pathways are involved. This strongly suggests that a complex metabolic switch accompanies EGA. In vitro conditions significantly altered RNA profiles before EGA, and the character of these changes indicates that they originate...

  18. Relative sensitivity of five Hawaiian coral species to high temperature under high-pCO2 conditions

    Science.gov (United States)

    Bahr, Keisha D.; Jokiel, Paul L.; Rodgers, Ku'ulei S.

    2016-06-01

    Coral reef ecosystems are presently undergoing decline due to anthropogenic climate change. The chief detrimental factors are increased temperature and increased pCO2. The purpose of this study was to evaluate the effect of these two stressors operating independently and in unison on the biological response of common Hawaiian reef corals. Manipulative experiments were performed using five species ( Porites compressa, Pocillopora damicornis, Fungia scutaria, Montipora capitata, and Leptastrea purpurea) in a continuous-flow mesocosm system under natural sunlight conditions. Corals were grown together as a community under treatments of high temperature (2 °C above normal maximum summer temperature), high pCO2 (twice present-day conditions), and with both factors acting in unison. Control corals were grown under present-day pCO2 and at normal summer temperatures. Leptastrea purpurea proved to be an extremely hardy coral. No change in calcification or mortality occurred under treatments of high temperature, high pCO2, or combined high temperature-high pCO2. The remaining four species showed reduced calcification in the high-temperature treatment. Two species ( L. purpurea and M. capitata) showed no response to increased pCO2. Also, high pCO2 ameliorated the negative effect of high temperature on the calcification rates of P. damicornis. Mortality was driven primarily by high temperature, with a negative synergistic effect in P. compressa only in the high-pCO2-high-temperature treatment. Results support the observation that biological response to temperature and pCO2 elevation is highly species-specific, so generalizations based on response of a single species might not apply to a diverse and complex coral reef community.

  19. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories

    Science.gov (United States)

    Amblàs-Novellas, J; Murray, S A; Espaulella, J; Martinez-Muñoz, M; Blay, C; Gómez-Batiste, X

    2016-01-01

    Objectives 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. Setting 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban–rural district in Barcelona, Spain. Participants 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. Outcome measures The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. Results The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (ppalliative approach. PMID:27645556

  20. Community Care for People with Chronic Conditions: An Analysis of Nine Studies of Health and Social Service Utilization in Ontario

    OpenAIRE

    Watt, Susan; Browne, Gina; Gafni, Amiram; Roberts, Jacqueline; Byrne, Carolyn

    1999-01-01

    A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same–or even lower–costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, atleast in a system of national health insurance, will...

  1. Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act. Final rules.

    Science.gov (United States)

    2015-11-18

    This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules.

  2. Modelling conditions and health care processes in electronic health records: an application to severe mental illness with the clinical practice research datalink

    OpenAIRE

    Olier, I.; Springate, DA; Ashcroft, DM; Doran, T.; Reeves, D; Planner, C.; Reilly, S; Kontopantelis, E

    2016-01-01

    Background The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rp...

  3. Sensitivity to initial conditions of a d -dimensional long-range-interacting quartic Fermi-Pasta-Ulam model: Universal scaling

    Science.gov (United States)

    Bagchi, Debarshee; Tsallis, Constantino

    2016-06-01

    We introduce a generalized d -dimensional Fermi-Pasta-Ulam model in the presence of long-range interactions, and perform a first-principle study of its chaos for d =1 ,2 ,3 through large-scale numerical simulations. The nonlinear interaction is assumed to decay algebraically as dij -α (α ≥0 ) , {di j} being the distances between N oscillator sites. Starting from random initial conditions we compute the maximal Lyapunov exponent λmax as a function of N . Our N ≫1 results strongly indicate that λmax remains constant and positive for α /d >1 (implying strong chaos, mixing, and ergodicity), and that it vanishes like N-κ for 0 ≤α /d 1 . The value α /d =1 can therefore be seen as a critical point separating the ergodic regime from the anomalous one, κ playing a role analogous to that of an order parameter. This scaling law is consistent with Boltzmann-Gibbs statistics for α /d >1 , and possibly with q statistics for 0 ≤α /d <1 .

  4. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

    Directory of Open Access Journals (Sweden)

    Reuven Rasooly

    2016-05-01

    Full Text Available Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB, and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1 image stacking to improve signal-to-noise ratios; (2 lasers to enable fluorescence excitation for flow cytometry; and (3 streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities, and provide for their use in low-cost medical diagnostics in resource-poor settings.

  5. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health.

    Science.gov (United States)

    Rasooly, Reuven; Bruck, Hugh Alan; Balsam, Joshua; Prickril, Ben; Ossandon, Miguel; Rasooly, Avraham

    2016-01-01

    Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings. PMID:27196933

  6. RNA profiles of porcine embryos during genome activation reveal complex metabolic switch sensitive to in vitro conditions.

    Directory of Open Access Journals (Sweden)

    Olga Østrup

    Full Text Available Fertilization is followed by complex changes in cytoplasmic composition and extensive chromatin reprogramming which results in the abundant activation of totipotent embryonic genome at embryonic genome activation (EGA. While chromatin reprogramming has been widely studied in several species, only a handful of reports characterize changing transcriptome profiles and resulting metabolic changes in cleavage stage embryos. The aims of the current study were to investigate RNA profiles of in vivo developed (ivv and in vitro produced (ivt porcine embryos before (2-cell stage and after (late 4-cell stage EGA and determine major metabolic changes that regulate totipotency. The period before EGA was dominated by transcripts responsible for cell cycle regulation, mitosis, RNA translation and processing (including ribosomal machinery, protein catabolism, and chromatin remodelling. Following EGA an increase in the abundance of transcripts involved in transcription, translation, DNA metabolism, histone and chromatin modification, as well as protein catabolism was detected. The further analysis of members of overlapping GO terms revealed that despite that comparable cellular processes are taking place before and after EGA (RNA splicing, protein catabolism, different metabolic pathways are involved. This strongly suggests that a complex metabolic switch accompanies EGA. In vitro conditions significantly altered RNA profiles before EGA, and the character of these changes indicates that they originate from oocyte and are imposed either before oocyte aspiration or during in vitro maturation. IVT embryos have altered content of apoptotic factors, cell cycle regulation factors and spindle components, and transcription factors, which all may contribute to reduced developmental competence of embryos produced in vitro. Overall, our data are in good accordance with previously published, genome-wide profiling data in other species. Moreover, comparison with mouse and

  7. [Optimal conditions for the functioning of a urease-based biosensor and pH-sensitive field transistors. Determination of urea in solution].

    Science.gov (United States)

    Bubriak, O A; Soldatkin, A P; Starodub, N F; El'skaia, A V; Shul'ga, A A; Strikha, V I

    1993-01-01

    The article deals with the optimal conditions of urea determination in solution by the enzyme sensor based on pH-sensitive field effect transistor. The dependence of response level on temperature, pH, ionic strength, buffer capacity were investigated. 10 mM phosphate buffer, pH 7.4 containing 200 mM NaCl is optimal for possible measurements of urea in diluted blood. Temperature change in the measured samples from 15 degrees to 30 degrees C does not affect the sensor signal value. Stability of immobilized ureas was investigated at storage under different conditions. In the presence of 1 mM EDTA activity of immobilized enzyme does not change during one month storage at 4 degrees C.

  8. O6-Methylguanine-Methyltransferase (MGMT Promoter Methylation Status in Glioma Stem-Like Cells is Correlated to Temozolomide Sensitivity Under Differentiation-Promoting Conditions

    Directory of Open Access Journals (Sweden)

    Lucie Karayan-Tapon

    2012-06-01

    Full Text Available Glioblastoma (GBM is the most malignant type of primary brain tumor with a very poor prognosis. The actual standard protocol of treatment for GBM patients consists of radiotherapy and concomitant temozolomide (TMZ. However, the therapeutic efficacy of this treatment is limited due to tumor recurrence and TMZ resistance. Recently isolated, glioma stem-like cells (GSCs are thought to represent the population of tumorigenic cells responsible for GBM resistance and recurrence following surgery and chemotherapy. In addition, MGMT (O6-methylguanine-methyltransferase methylation is considered as one of the principal mechanisms contributing to TMZ sensitivity of GBM. In this study we have isolated GSCs from 10 adult GBM patients and investigated the relationship between MGMT methylation status and Temozolomide (TMZ sensitivity of these lines grown either in stem-like or differentiation promoting conditions. Sensitivity to TMZ was significantly associated with MGMT methylation status in cells committed to differentiation but not in stem-like cells. In addition, patients harboring highly methylated MGMT promoters had a longer overall survival. These results reveal the importance of the differentiation process when considering the predictive value of MGMT status in GSCs for clinical response to TMZ.

  9. Psychometric Properties of a Generic, Patient-Centred Palliative Care Outcome Measure of Symptom Burden for People with Progressive Long Term Neurological Conditions

    Science.gov (United States)

    Gao, Wei; Crosby, Vincent; Wilcock, Andrew; Burman, Rachael; Silber, Eli; Hepgul, Nilay; Chaudhuri, K Ray; Higginson, Irene J.

    2016-01-01

    Background There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. Data and Methods Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The IPOS Neuro-S8 was assessed for its data quality, score distribution, ceiling and floor effects, reliability, factor structure, convergent and discriminant validity, concurrent validity with generic (Palliative care Outcome Scale) and condition specific measures (Multiple Sclerosis Impact Scale; Non-motor Symptoms Questionnaire; Parkinson’s Disease Questionnaire), responsiveness and minimally clinically important difference. Results Of the 134 participants, MS patients had a mean Extended Disability Status Scale score 7.8 (SD = 1.0), patients with an IPD, MSA or PSP were in Hoehn & Yahr stage 3–5. The IPOS Neuro-S8 had high data quality (2% missing), mean score 8 (SD = 5; range 0–32), no ceiling effects, borderline floor effects, good internal consistency (Cronbach’s α = 0.7) and moderate test-retest reliability (intraclass coefficient = 0.6). The results supported a moderately correlated two-factor structure (Pearson’s r = 0.5). It was moderately correlated with generic and condition specific measures (Pearson’s r: 0.5–0.6). There was some evidence for discriminant validity in IPD, MSA and PSP (p = 0.020), and for good responsiveness and longitudinal construct validity. Conclusions IPOS Neuro-S8 shows acceptable to promising psychometric properties in common forms of progressive LTNCs. Future work needs to confirm these findings with larger samples and its usefulness in wider disease groups. PMID

  10. The problems of the providing the regions with health care infrastructure in conditions of increase of migratory mobility

    Directory of Open Access Journals (Sweden)

    Yelena Borisovna Bedrina

    2013-06-01

    Full Text Available Subject matter of the article is a question of the providing the newcomers to regions of the Russian Federation with healthcare infrastructure facilities. The purpose of the research is an assessment of level of this providing. On the basis of calculation of the integrated indicators of the development of health care infrastructure and the providing the population with healthcare infrastructure facilities the grouping of regions is carried out. By means of the two-dimensional analysis, we made a comparison of regions on indicators of arrival of the population and the above-named settlement indicators. The analysis of dynamics of the number change of healthcare infrastructure facilities during its reforming from 2005 to 2011 is performed. As a result of the research, the following conclusion is drawn: the level of investment into the regions as well as in its health care infrastructure do influence on the intensity of migratory flows, however, distribution of investments into health care facilities in regions does not take in to account the directions of migratory flows and poorly considers the population size of territories. This article may be interesting to the experts dealing with issues of development of regions.

  11. A Rapid and Sensitive Next-Generation Sequencing Method to Detect RB1 Mutations Improves Care for Retinoblastoma Patients and Their Families.

    Science.gov (United States)

    Li, Wenhui L; Buckley, Jonathan; Sanchez-Lara, Pedro A; Maglinte, Dennis T; Viduetsky, Lucy; Tatarinova, Tatiana V; Aparicio, Jennifer G; Kim, Jonathan W; Au, Margaret; Ostrow, Dejerianne; Lee, Thomas C; O'Gorman, Maurice; Judkins, Alexander; Cobrinik, David; Triche, Timothy J

    2016-07-01

    Retinoblastoma is a childhood eye malignancy that can lead to the loss of vision, eye(s), and sometimes life. The tumors are initiated by inactivating mutations in both alleles of the tumor-suppressor gene, RB1, or, rarely, by MYCN amplification. Timely identification of a germline RB1 mutation in blood samples or either somatic RB1 mutation or MYCN amplification in tumors is important for effective care and management of retinoblastoma patients and their families. However, current procedures to thoroughly test RB1 mutations are complicated and lengthy. Herein, we report a next-generation sequencing-based method capable of detecting point mutations, small indels, and large deletions or duplications across the entire RB1 gene and amplification of MYCN gene on a single platform. From DNA extraction to clinical interpretation requires only 3 days, enabling early molecular diagnosis of retinoblastoma and optimal treatment outcomes. This method can also detect low-level mosaic mutations in blood samples that can be missed by routine Sanger sequencing. In addition, it can differentiate between RB1 mutation- and MYCN amplification-driven retinoblastomas. This rapid, comprehensive, and sensitive method for detecting RB1 mutations and MYCN amplification can readily identify RB1 mutation carriers and thus improve the management and genetic counseling for retinoblastoma patients and their families. PMID:27155049

  12. A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision-Making in End-of-Life Care in the US.

    Science.gov (United States)

    Clint Parker, J; Goldberg, Daniel S

    2016-03-01

    The central claim of this paper is that American states' use of so-called "triggering conditions" to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations (including epistemic difficulties), and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. PMID:26084270

  13. Non-neuronal, but atropine-sensitive ileal contractile responses to short-chain fatty acids: age-dependent desensitization and restoration under inflammatory conditions in mice.

    Science.gov (United States)

    Yajima, Masako; Kimura, Shunsuke; Karaki, Shinichiro; Nio-Kobayashi, Junko; Tsuruta, Takeshi; Kuwahara, Atsukazu; Yajima, Takaji; Iwanaga, Toshihiko

    2016-04-01

    Intestinal epithelial cells sense short-chain fatty acids (SCFAs) to secrete non-neuronal acetylcholine (ACh). However, the roles of luminalSCFAs and epithelialACh under normal and pathological conditions remain unknown. We examined ileal contractile responses toSCFAs at different ages and their mucosal cholinergic alterations under inflammatory conditions. Ileal contractile responses toSCFAs in 1-day-old pups to 7-week-old mice were compared using an isotonic transducer, and responses to an intraperitoneal injection of lipopolysaccharide (LPS) were analyzed in 7-week-old mice. ThemRNAexpression levels of aSCFAactivate free fatty acid receptor, acetylcholinesterase (AChE), choline acetyltransferase (Chat), and choline transporter-like protein 4 (CTL4) were measured using real-time quantitativeRT-PCRAChE was analyzed by histochemical and optical enzymatic assays. Atropine-sensitive ileal contractile responses toSCFAs occurred in all 1-day-old pups, but were frequently desensitized after the weaning period. These contractile responses were not inhibited by tetrodotoxin and did not appear when the mucosal layer had been scraped off. Contractile desensitization in 7-week-old mice was abolished in the presence of theAChE inhibitor, eserine, which was consistent with increasedAChE activity after weaning. Ileal contractions toSCFAs in adult mice were restored byLPS, which significantly increased the epithelialmRNAexpression of Chat andCTL4. Atropine-sensitive ileal contractile responses toSCFAs constitutively occur in the newborn period, and are desensitized during developmental stages following the up-regulated expression ofAChE in the villous mucosa, but are restored under inflammatory conditions possibly via the release of epithelialACh. PMID:27053293

  14. Comparison of Surfactant Distributions in Pressure-Sensitive Adhesive Films Dried from Dispersion under Lab-Scale and Industrial Drying Conditions.

    Science.gov (United States)

    Baesch, S; Siebel, D; Schmidt-Hansberg, B; Eichholz, C; Gerst, M; Scharfer, P; Schabel, W

    2016-03-01

    Film-forming latex dispersions are an important class of material systems for a variety of applications, for example, pressure-sensitive adhesives, which are used for the manufacturing of adhesive tapes and labels. The mechanisms occurring during drying have been under intense investigations in a number of literature works. Of special interest is the distribution of surfactants during the film formation. However, most of the studies are performed at experimental conditions very different from those usually encountered in industrial processes. This leaves the impact of the drying conditions and the resulting influence on the film properties unclear. In this work, two different 2-ethylhexyl-acrylate (EHA)-based adhesives with varying characteristics regarding glass transition temperature, surfactants, and particle size distribution were investigated on two different substrates. The drying conditions, defined by film temperature and mass transfer in the gas phase, were varied to emulate typical conditions encountered in the laboratory and industrial processes. Extreme conditions equivalent to air temperatures up to 250 °C in a belt dryer and drying rates of 12 g/(m(2)·s) were realized. The surfactant distributions were measured by means of 3D confocal Raman spectroscopy in the dry film. The surfactant distributions were found to differ significantly with drying conditions at moderate film temperatures. At elevated film temperatures the surfactant distributions are independent of the investigated gas side transport coefficients: the heat and mass transfer coefficient. Coating on substrates with significantly different surface energies has a large impact on surfactant concentration gradients, as the equilibrium between surface and bulk concentration changes. Dispersions with higher colloidal stability showed more homogeneous lateral surfactant distributions. These results indicate that the choice of the drying conditions, colloidal stability, and substrates is crucial

  15. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care.

    Science.gov (United States)

    Etkind, S N; Koffman, J

    2016-07-01

    Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area.

  16. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care.

    Science.gov (United States)

    Etkind, S N; Koffman, J

    2016-07-01

    Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area. PMID:27129911

  17. Competition and sensitivity of wheat and wild oat exposed to enhanced UV-B radiation at different densities under field conditions

    International Nuclear Information System (INIS)

    The influence of enhanced UV-B radiation (approximating a 15% ozone layer reduction) on competitive interaction between spring wheat (Triticum aestivum) and wild oat (Avena fatua) was examined in the field. The density-dependent mortality of both wheat and wild oat did not exhibit a significant difference between control and UV-B treatment conditions. A relatively high degree of competitive stress enhanced the effects of UV-B stress on biomass reduction. The relative competitive status of wheat in terms of total biomass increased under UV-B enhancement while it decreased when based upon grain production. Shifts in competitive balance occurred with significant changes in total biomass, especially when plants grew at higher densities in monocultures and mixtures. The sensitivity of wild oat to intensification of UV-B radiation at higher densities in mixtures was greater than that at lower densities. At all densities examined, wheat grown in mixture was significantly less sensitive to UV-B radiation than that in monoculture, and just the opposite for wild oat. The density of monocultures did not alter the response index (RI) of wheat and wild oat to enhanced UV-B radiation. (author)

  18. Uncertainty and sensitivity analysis for two-phase flow in the vicinity of the repository in the 1996 performance assessment for the Waste Isolation Pilot Plant: Undisturbed conditions

    Energy Technology Data Exchange (ETDEWEB)

    HELTON,JON CRAIG; BEAN,J.E.; ECONOMY,K.; GARNER,J.W.; MACKINNON,ROBERT J.; MILLER,JOEL D.; SCHREIBER,JAMES D.; VAUGHN,PALMER

    2000-05-19

    Uncertainty and sensitivity analysis results obtained in the 1996 performance assessment for the Waste Isolation Pilot Plant are presented for two-phase flow the vicinity of the repository under undisturbed conditions. Techniques based on Latin hypercube sampling, examination of scatterplots, stepwise regression analysis, partial correlation analysis and rank transformation are used to investigate brine inflow, gas generation repository pressure, brine saturation and brine and gas outflow. Of the variables under study, repository pressure is potentially the most important due to its influence on spallings and direct brine releases, with the uncertainty in its value being dominated by the extent to which the microbial degradation of cellulose takes place, the rate at which the corrosion of steel takes place, and the amount of brine that drains from the surrounding disturbed rock zone into the repository.

  19. Optimization of Extraction Conditions and Development of a Sensitive HPTLC Method for Estimation of Wedelolactone in different extracts of Eclipta alba

    Directory of Open Access Journals (Sweden)

    Kulkarni Savita

    2011-01-01

    Full Text Available Eclipta alba has been used in Ayurvedic medicine for treatment of various ailments. An attempt has been made to optimize different extraction conditions for Eclipta alba. Further an accurate, precise, reproducible and sensitive accurate, precise and reproducible (HPTLC method has been developed for the estimation of Wedelolactone in Eclipta alba. An attempt has been made to quantify wedelolactone in various extracts by HPTLC method. Precoated aluminum silica gel F plates were used as stationary phase and toluene: ethyl acetate (9:1 was used as mobile phase. This system was found to give compact spots for wedelolactone (RF value of 0.30 ± 0. 3 with a linearity range of 1 to 80 µg per spot. The proposed method was applied to evaluate efficiency of different methods of extraction i.e. percolation, maceration, hot solvent extraction (Soxhlet apparatus, supercritical fluid extraction, microwave, orbital shaker bath and sonication method for extraction of wedelolactone from Eclipta alba.

  20. Prescription Drug Use Among Adults With Chronic Conditions in South Korea: Dual Burden of Health Care Needs and Socioeconomic Vulnerability.

    Science.gov (United States)

    Jung, Youn; Byeon, Jinok; Chung, Haejoo

    2016-01-01

    The aim of this study is to identify the social determinants of prescription drug use among adults with chronic diseases by examining the associations between socioeconomic position and prescription medicine use and perceived burden for pharmaceutical expenditure, using a sample of the Korean population from the 2008 Korea Health Panel, with 4 analytic models. Controlled with health status and the type of health insurance, the probability of using prescription drugs and overall spending on drugs significantly increased with rising income level, while perceived burden for out-of-pocket payment significantly decreased. These results imply that the poor are likely to underuse prescription drugs compared with their wealthier counterparts with the same need for health care, probably due to economic barriers. PMID:26512028

  1. P-polarized reflectance spectroscopy: A high sensitive real-time monitoring technique to study surface kinetics under steady state epitaxial deposition conditions

    Science.gov (United States)

    Dietz, Nikolaus; Bachmann, Klaus J.

    1995-01-01

    This paper describes the results of real-time optical monitoring of epitaxial growth processes by p-polarized reflectance spectroscopy (PRS) using a single wavelength application under pulsed chemical beam epitaxy (PCBE) condition. The high surface sensitivity of PRS allows the monitoring of submonolayer precursors coverage on the surface as shown for GaP homoepitaxy and GaP on Si heteroepitaxy as examples. In the case of heteroepitaxy, the growth rate and optical properties are revealed by PRS using interference oscillations as they occur during growth. Super-imposed on these interference oscillations, the PRS signal exhibits a fine structure caused by the periodic alteration of the surface chemistry by the pulsed supply of chemical precursors. This fine structure is modeled under conditions where the surface chemistry cycles between phosphorus supersaturated and phosphorus depleted surfaces. The mathematical model describes the fine structure using a surface layer that increases during the tertiarybutyl phosphine (TBP) supply and decreases during and after the triethylgallium (TEG) pulse, which increases the growing GaP film thickness. The imaginary part of the dielectric function of the surface layer is revealed from the turning points in the fine structure, where the optical response to the first precursor pulse in the cycle sequence changes sign. The amplitude of the fine structure is determined by the surface layer thickness and the complex dielectric functions for the surface layer with the underlying bulk film. Surface kinetic data can be obtained by analyzing the rise and decay transients of the fine structure.

  2. Hospice Care

    Science.gov (United States)

    ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ... to the Terms and Conditions and Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium ...

  3. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

    Directory of Open Access Journals (Sweden)

    Peters Sarah

    2011-12-01

    Full Text Available Abstract Background The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME] within a primary care setting. Methods A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. Results Analyses identified four sets of challenges that were common to both interventions: (i being a novice therapist, (ii engaging patients in the therapeutic model, (iii dealing with emotions, and (iv the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. Conclusions Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found

  4. Sensitivity of a third generation wave model to wind and boundary condition sources and model physics: A case study from the South Atlantic Ocean off Brazil coast

    Science.gov (United States)

    Siadatmousavi, S. Mostafa; Jose, Felix; Miot da Silva, Graziela

    2016-05-01

    Three different packages describing the white capping dissipation process, and the corresponding energy input from wind to wave were used to study the surface wave dynamics in South Atlantic Ocean, close to the Brazilian coast. A host of statistical parameters were computed to evaluate the performance of wave model in terms of simulated bulk wave parameters. Wave measurements from a buoy deployed off Santa Catarina Island, Southern Brazil and data along the tracks of Synthetic Aperture Radars were compared with simulated bulk wave parameters; especially significant wave height, for skill assessment of different packages. It has been shown that using a single parameter representing the performance of source and sink terms in the wave model, or relying on data from only one period of simulations for model validation and skill assessment would be misleading. The model sensitivity to input parameters such as time step and grid size were addressed using multiple datasets. The wind data used for the simulation were obtained from two different sources, and provided the opportunity to evaluate the importance of input data quality. The wind speed extracted from remote sensing satellites was compared to wind datasets used for wave modeling. The simulation results showed that the wind quality and its spatial resolution is highly correlated to the quality of model output. Two different sources of wave information along the open boundaries of the model domain were used for skill assessment of a high resolution wave model for the study area. It has been shown, based on the sensitivity analysis, that the effect of using different boundary conditions would decrease as the distance from the open boundary increases; however, the difference were still noticeable at the buoy location which was located 200-300 km away from the model boundaries; but restricted to the narrow band of the low frequency wave spectrum.

  5. Maternal Care Determinant of Longevity?

    Science.gov (United States)

    Giorgio, Marco; Renzi, Chiara; Oliveri, Serena; Pravettoni, Gabriella

    2016-04-01

    Maternal care is an essential early environment in mammals that ensures emotional regulation and adaptive fitness of progeny. Longevity and healthy aging are associated with favorable environmental factors including fitting social and behavioral features. In the present review, we discuss the findings that link rearing conditions and early maternal care with life span and aging from an evolutionary, psychological, and molecular perspective. The quality of maternal care may influence internal adaptation through a variety of parallel mechanisms including emotional regulation, stress sensitivity, coping and other behavioral strategies in response to events requiring adaptation. From a biological perspective, it regulates physiological pathways that may persist in adulthood through epigenetic mechanisms, influencing disease susceptibility and, potentially, longevity. Abnormal maternal care induces maladaptation that persists over the life span, may accelerate the onset of aging associated diseases, and shorten life span. This may have important implications in the development of preventive approaches and early interventions. PMID:27548096

  6. Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data

    OpenAIRE

    Vale, C.L.; Burdett, S; Rydzewska, L. H.; Albiges, L; Clarke, N W; Fisher, D; Fizazi, K; Gravis, G.; James, N. D.; Mason, M D; Parmar, M. K.; Sweeney, C. J.; Sydes, M. R.; Tombal, B.; Tierney, J. F.

    2016-01-01

    Summary Background Results from large randomised controlled trials combining docetaxel or bisphosphonates with standard of care in hormone-sensitive prostate cancer have emerged. In order to investigate the effects of these therapies and to respond to emerging evidence, we aimed to systematically review all relevant trials using a framework for adaptive meta-analysis. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, LILACS, and the Cochrane Central Register o...

  7. Stimuli-Sensitive Hydrogel Based on N-Isopropylacrylamide and Itaconic Acid for Entrapment and Controlled Release of Candida rugosa Lipase under Mild Conditions

    Directory of Open Access Journals (Sweden)

    Nikola Milašinović

    2014-01-01

    Full Text Available Stimuli responsive pH- and temperature-sensitive hydrogel drug delivery systems, as those based on N-isopropylacrylamide (NiPAAm and itaconic acid (IA, have been attracting much of the attention of the scientific community nowadays, especially in the field of drug release. By adjusting comonomer composition, the matrix is enabled to protect the incorporated protein in the highly acidic environment of upper gastrointestinal tract and deliver it in the neutral or slightly basic region of the lower intestine. The protein/poly(NiPAAm-co-IA hydrogels were synthetized by free radical crosslinking copolymerization and were characterized concerning their swelling capability, mechanical properties, and morphology. The pore structure and sizes up to 1.90 nm allowed good entrapment of lipase molecules. Model protein, lipase from Candida rugosa, was entrapped within hydrogels upon mild conditions that provided its protection from harmful environmental influences. The efficiency of the lipase entrapment reached 96.7%, and was dependent on the initial concentration of lipase solution. The swelling of the obtained hydrogels in simulated pH and temperature of gastrointestinal tract, the lipase entrapment efficiency, and its release profiles from hydrogels were investigated as well.

  8. Actual Condition of Quality Control of X-ray Imaging System in Primary Care Institution: focused on Gwangju Metropolitan City

    International Nuclear Information System (INIS)

    With the expanded use of radiation in modern medical practices, the most important issue in regards to efforts to reduce individual exposure dose is quality assurance. Therefore in order to study the present condition of quality assurance, the Gwangju Metropolitan City area was divided into five districts each containing ten hospitals. Four experiments were conducted: a reproducibility experiment for kVp, mA, and examination time (sec) intensity of illumination; half-value layer (HVL) measurement; and beam perpendicularity test matching experiment. The tube voltage reproducibility experiment for all fifty hospitals resulted in a 95.33% passing rate and mA and examination time both resulted in a 77.0% passing rate. The passing rate for intensity of illumination was 86.0% and 52.0% for HVL, which was the lowest passing rate of all four factors. For the beam perpendicularity test matching experiment, generally the central flux is matched to within 1.5.deg. . Of all fifty hospitals 30.0% were beyond 3.deg. . The results of the survey showed that 58% responded that they knew about quality assurance cycle. All fifty respondents stated that they have not received any training in regards to quality assurance at their current place of employment. Although quality assurance is making relative progress, the most urgent issue is awareness of the importance of quality assurance. Therefore, the implementation of professional training focusing on safety management and accurate quality assurance of radiation will reduce the exposure to radiation for radiologists and patients and higher quality imaging using less dosage will also be possible

  9. Palliative care: a challenge for orthopaedic nursing care.

    Science.gov (United States)

    Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry

    2005-01-01

    Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

  10. Effect of temperature on the galvanic corrosion of a duplex stainless steel in its sensitized and un-sensitized condition in 992 g/l aqueous LiBr solution

    Energy Technology Data Exchange (ETDEWEB)

    Leiva-Garcia, R.; Munoz-Portero, M.J.; Garcia-Anton, J. [Valencia Univ. Politecnica, Dept. de Ingenieria Quimica y Nuclear. ETSI Industriales, Valencia (Spain)

    2009-07-01

    Corrosion resistance of duplex stainless steels can decrease if, due to an improper heat treatment, the formation of intermetallic phases is induced and local alloying element depletion occurs. The aim of this work is to study the corrosion behaviour of a sensitized and un-sensitized duplex stainless steel (Alloy 900) in 992 g/L aqueous Lithium Bromide solutions at different temperatures (25 C, 50 C, and 75 C). The sensitized sample has been heat treated at 825 C during 1 hour in an inert atmosphere. The sigma phase is observed in the sensitized sample; this phase decreases the corrosion resistance and mechanical properties of Alloy 900. In order to evaluate the different corrosion parameters (open circuit potential (OCP), corrosion potential, pitting potential, re-passivation potential, corrosion current density, passivation current density, and re-passivation current density), cyclic potentiodynamic tests were conducted in the 992 g/L aqueous Lithium Bromide solution using the electro-optical devices P-200002525 y P-200002526. These devices permit the acquisition of images of the electrode surface and electrochemical data simultaneously. The OCP increases with temperature and it is more positive for the sensitized sample. This can be due to morphological changes as a consequence of the heat treatment; the ferrite percentage decreases in the sensitized sample with the used heat treatment. The results show that the corrosion potential increases with temperature and it is more positive in the sensitized sample than for the un-sensitized sample. The pitting potential decreases as a consequence of the temperature and the heat treatment. When the pitting potential drops, the local corrosion resistance decreases. Pit formation is visible on the surface images obtained during the electrochemical tests when the potentiodynamic curve is close to the pitting potential. (authors)

  11. Effect of temperature on the galvanic corrosion of a duplex stainless steel in its sensitized and un-sensitized condition in 992 g/l aqueous LiBr solution

    International Nuclear Information System (INIS)

    Corrosion resistance of duplex stainless steels can decrease if, due to an improper heat treatment, the formation of intermetallic phases is induced and local alloying element depletion occurs. The aim of this work is to study the corrosion behaviour of a sensitized and un-sensitized duplex stainless steel (Alloy 900) in 992 g/L aqueous Lithium Bromide solutions at different temperatures (25 C, 50 C, and 75 C). The sensitized sample has been heat treated at 825 C during 1 hour in an inert atmosphere. The sigma phase is observed in the sensitized sample; this phase decreases the corrosion resistance and mechanical properties of Alloy 900. In order to evaluate the different corrosion parameters (open circuit potential (OCP), corrosion potential, pitting potential, re-passivation potential, corrosion current density, passivation current density, and re-passivation current density), cyclic potentiodynamic tests were conducted in the 992 g/L aqueous Lithium Bromide solution using the electro-optical devices P-200002525 y P-200002526. These devices permit the acquisition of images of the electrode surface and electrochemical data simultaneously. The OCP increases with temperature and it is more positive for the sensitized sample. This can be due to morphological changes as a consequence of the heat treatment; the ferrite percentage decreases in the sensitized sample with the used heat treatment. The results show that the corrosion potential increases with temperature and it is more positive in the sensitized sample than for the un-sensitized sample. The pitting potential decreases as a consequence of the temperature and the heat treatment. When the pitting potential drops, the local corrosion resistance decreases. Pit formation is visible on the surface images obtained during the electrochemical tests when the potentiodynamic curve is close to the pitting potential. (authors)

  12. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties

    Directory of Open Access Journals (Sweden)

    A. Hally

    2014-05-01

    Full Text Available The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6 and Intensive Observation Period 7a (IOP7a, occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC and boundary (BC conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physics and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high and low-level flow is weak to moderate (strong, the level of dispersion of the ICBC and physical perturbation ensembles is (is not comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  13. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties

    Directory of Open Access Journals (Sweden)

    A. Hally

    2013-12-01

    Full Text Available The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6 and Intensive Observation Period 7a (IOP7a, occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC and boundary (BC conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physic and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high and low-level flow is weak to moderate (strong, the level of dispersion of the ICBC and physical perturbation ensembles is (is not comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  14. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties

    Science.gov (United States)

    Hally, A.; Richard, E.; Ducrocq, V.

    2014-05-01

    The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs) in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6) and Intensive Observation Period 7a (IOP7a), occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC) and boundary (BC) conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physics and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high) and low-level flow is weak to moderate (strong), the level of dispersion of the ICBC and physical perturbation ensembles is (is not) comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  15. A new coupled ice sheet/climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke

    2011-03-01

    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  16. A new coupled ice sheet-climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke

    2010-08-01

    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model, that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  17. Sensitivity of East Asian Climate to the Progressive Uplift and Expansion of the Tibetan Plateau Under the Mid-Pliocene Boundary Conditions

    Institute of Scientific and Technical Information of China (English)

    JIANG Dabang; DING Zhongli; Helge DRANGE; GAO Yongqi

    2008-01-01

    A global atmospheric general circulation model has been used to perform eleven idealized numerical experimenta,i.e.,TP00,TPl0,…,TPl00,corresponding to different percentages of the Tibetan Plateau altitude.The aim is to explore the sensitivity of East Asian climate to the uplift and expansion of the Tibetan Plateau under the reconstructed boundary conditions for the mid-Pliocene about 3 Ma ago.When the plateau is progressively uplifted,global annual surface temperature is gradually declined and statistically significant cooling signals emerge only in the Northern Hemisphere,especially over and around the Tibetan Plateau.with larger magnitudes over land than over the oceans.0n the contrary,annual surface temperature rises notably over Central Asia and most parts of Africa,as well as over northeasternmost Eurasia in the experiments TP60 to TP100.Meanwhile.the plateau uplift also leads to annual precipitation augmentation over the Tibetan Plateau but a reduction in northern Asia,the Indian Peninsula,much of Central Asia,parts of western Asia and the southern portions of northeastern Europe.Additionally,it is found that an East Asian summer monsoon system similar to that of the present initially exists in the TP60 and is gradually intensified with the continued plateau uplift.At 850 hPa the plateau uplift induces an anomalous cyclonic circulation around the Tibetan Plateau in summertime and two anomalous westerly currents respectively located to the south and north of the Tibetan Plateau in wintertime.In the mid-troposphere,similar-to-modern spatial pattern of summertime western North Pacific subtropical high is only exhibited in the experiments TP60 to TP100,and the East Asian trough is steadily deepened in response to the progressive uplift and expansion of the Tibetan Plateau.

  18. A new coupled ice sheet-climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Science.gov (United States)

    Fyke, J. G.; Weaver, A. J.; Pollard, D.; Eby, M.; Carter, L.; Mackintosh, A.

    2010-08-01

    The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model, that consists of the University of Victoria Earth System Climate Model (UVic ESCM) and the Pennsylvania State University Ice model (PSUI). The climate model generates a surface mass balance (SMB) field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT) biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet. A number of simulations for late Holocene, Last Glacial Maximum (LGM), and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  19. A new coupled ice sheet/climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Science.gov (United States)

    Fyke, J. G.; Weaver, A. J.; Pollard, D.; Eby, M.; Carter, L.; Mackintosh, A.

    2011-03-01

    The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model that consists of the University of Victoria Earth System Climate Model (UVic ESCM) and the Pennsylvania State University Ice model (PSUI). The climate model generates a surface mass balance (SMB) field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT) biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet. A number of simulations for late Holocene, Last Glacial Maximum (LGM), and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  20. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain).

    Science.gov (United States)

    Esteban-Vasallo, María D; Domínguez-Berjón, M Felicitas; Gil-Prieto, Ruth; Astray-Mochales, Jenaro; Gil de Miguel, Angel

    2014-01-01

    The objectives of this study were to estimate incidence density rates (IDR) of herpes zoster (HZ) and to analyze the association with sociodemographic characteristics and selected chronic medical conditions. The study cohort consisted of the adult population included in the Public Health System of the Autonomous Community of Madrid, Spain on 1/10/2009 (5 244 402 persons). Data source were electronic medical records from primary care between 1/10/2009-31/12/2012. Individual socioeconomic status (SES) was inferred by geocoding. Poisson regression analyses were stratified by sex, to identify factors associated with HZ. We identified 81 541 incident cases of HZ (61.7% in women and 46.5% in the group aged 60 and over). IDR was 4.11 per 1000 person-years in men and 5.95 in women. IDR were higher with age, in autochthonous population, those with lower SES and in patients with immunodeficiencies. After adjustment, higher incidence rate ratios were found with age, autochthonous origin, lower SES, and in patients with HIV-infection/AIDS (3.20, CI95% 2.90-3.53 in men and 2.98, CI95% 2.58-3.45 in women), and other immunodeficiencies (1.57, CI95% 1.41-1.75 and 1.65, CI95% 1.50-1.80). COPD, asthma, DM, ischemic heart disease, other cardiovascular diseases, and cancer were also associated with an increased incidence of HZ. We conclude that older, autochthonous patients with lower SES and with certain underlying medical conditions had a higher probability of suffering HZ. Electronic databases are useful for estimating the incidence of HZ, and for finding associations with sociodemographic and clinical characteristics. Identifying unrecognized risk factors for HZ, such as asthma or cardiovascular diseases, is crucial to interpret the epidemiology of HZ, to target vaccination programs and to monitor their effect. PMID:24805130

  1. MAGNETIC RESONANCE IMAGING OF INTRACRANIAL INFLAMMATORY CONDITIONS IN DOGS: SENSITIVITY OF SUBTRACTION IMAGES VERSUS PRE- AND POST-GADOLINIUM T1-WEIGHTED IMAGE PAIRS.

    Science.gov (United States)

    Dirrig, Helen; Lamb, Christopher R

    2016-07-01

    Ante mortem diagnosis of canine meningoencephalitis is usually based on the results of neurologic examination, cerebrospinal fluid analysis and magnetic resonance (MR) imaging. It has been hypothesized that subtraction MR imaging may increase the sensitivity of MR for intracranial inflammatory lesions compared to conventional post-gadolinium T1-weighted imaging. Sensitivity of pre- and post-gadolinium (C-/C+) image pairs and dynamic subtraction (DS) images was compared in a retrospective diagnostic accuracy study of 52 dogs with inflammatory cerebrospinal fluid and 67 dogs with idiopathic epilepsy. Series of transverse C-/C+ and DS images were reviewed independently for signs of abnormal enhancement affecting the pachymeninges, leptomeninges or intra-axial structures. Sensitivity of C-/C+ image pairs and DS images was 48% (95% CI: 35-61%) and 65% (95% CI: 52-77%), respectively (P = 0.01). Intra-axial lesions were observed more frequently than meningeal lesions in both C-/C+ (43% vs. 31%) and DS images (61% vs. 22%). The difference in sensitivities of C-/C+ and DS series was entirely due to increased sensitivity of DS images for intra-axial lesions. Eight (12%) dogs with epilepsy had evidence of intra-axial gadolinium accumulation affecting the cerebral cortex in DS images. This finding may represent a false-positive result or a true sign of pathology, possibly associated with a leaky blood-brain barrier in areas of the brain affected by neovascularization secondary to repeated seizures. Results suggest that DS imaging has higher sensitivity than comparison of pre- and post-gadolinium image pairs for inflammatory intra-axial lesions. PMID:27144775

  2. Pediatric Palliative Care

    OpenAIRE

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palli...

  3. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Okunseri C

    2013-09-01

    Full Text Available Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC-related emergency department (ED visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors.Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables.Results: Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%–50% higher rates during non-working hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19–33 year olds, subjects <18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005. Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003. Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04.Conclusion: NTDC-related visits to ED occurred at a higher rate during non-working hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.Keywords: dental

  4. Sensitivity Characteristic Analysis of Adsorbent-Mixed Carbon Nanotube Sensors for the Detection of SF6 Decomposition Products under PD Conditions

    Directory of Open Access Journals (Sweden)

    Ju Tang

    2013-11-01

    Full Text Available Sulfur hexafluoride (SF6 gas decomposition results from the energy produced by partial discharge (PD. The detection of SO2 and H2S content, as important characteristic components of the decomposition products, is significant in the determination of the insulation level of SF6 gas and the inside insulation faults of gas-insulated equipment. A number of gas sensors use carbon nanotubes (CNTs. However, the applications of these sensors are limited by their low intrinsic sensitivity. In this paper, an adsorbent-mixed carbon nanotube gas sensor is proposed to improve the detection of SO2 and H2S concentrations. The sensitivity of adsorbent-mixed carbon nanotube gas sensors to SO2 and H2S at 100 ppm was investigated experimentally. The effect of the mixing ratio on the gas sensitivity characteristic and mechanism of response was also studied. The results show that compared with intrinsic CNTs gas sensors, the gas sensor featuring adsorbent-mixed CNTs has significantly higher sensitivity and responsiveness to SO2 and H2S. The resistance-change rate of SO2 and H2S increased to 33.7% and 50.9% from 0.96% and 12.9%, respectively. Moreover, the resistance-change rate and gas concentration satisfy a linear relationship. The sensor has good repeatability and stability.

  5. Assessment of the radiation sensitivity of patients after conditioning irradiation as preparation for bone marrow or stem cell transplantation; Ermittlung der Strahlenempfindlichkeit bei Patienten nach kondtionierender Bestrahlung zur Vorbereitung einer Knochemarks- bzw. Stammzellentransplantation

    Energy Technology Data Exchange (ETDEWEB)

    Severin, Erhard; Pascher, Elke; Greve, Burkhard; Wedemeyer, Niels; Kienast, Joachim; Willich, Normann; Goehde, Wofgang

    2005-07-01

    The knowledge on the radiation sensitivity of individual patients would allow a better planning of conditioning irradiation including the possibility of dose increase that might enhance the chance of a successful bone marrow or stem cell transplantation. The study was focused on the search of reliable and fast laboratory test procedures to predict the individual radiation sensitivity. Several blood tests were evaluated with respect to their appropriateness: mostly flow-cytometric test on lymphocytes: micronuclei, cell proliferation, apoptosis activation of cytokines and the total number of leucocytes, blood stem cells CD4+ and CD8+ lymphocytes, and a spectro-photometric test of blood plasma for the determination of the antioxidative capacity.

  6. 儿童危重症护理质量敏感性指标评价体系的初步研究%A preliminary study on evaluation system of children’s critical care quality sensitivity index

    Institute of Scientific and Technical Information of China (English)

    张艳红; 张玉侠; 胡静; 顾莺; 刘林霞

    2015-01-01

    Objective:To build a systematic and scientific and sensitive nursing quality evaluation system,so as to promote the continuous improvement of nursing quality in PICU.Methods:A total of 40 pediatric experts in va-rious regions in the whole country were selected by using the Delphi method to conduct two rounds of consulta-tion,And among them,10 high authority of experts were invited for focus group interviews.Results:After two rounds of consultation and expert focus group interview,finally the evaluation system of children’s critical care quality sensitivity index was obtained,including 3 the first level indexes,ten the second level indexes and 34 ter-tiary indicators.Conclusion:The evaluation system of children’s critical care quality sensitivity index was con-structed in preliminary.%[目的]构建一套系统、科学和敏感的护理质量评价体系,以促进儿童重症监护室护理质量的持续改进。[方法]选定全国各地区儿科专家40名,运用德尔菲法进行两轮函询,并邀请其中权威较高的10位专家进行焦点团体访谈。[结果]通过两轮函询以及专家焦点团体访谈后,最终得出儿童危重症护理质量敏感性指标评价体系,包括3个一级指标,10个二级指标,34个三级指标。[结论]初步构建了儿科危重症护理质量敏感性评价指标体系。

  7. Common Conditions in Newborns

    Science.gov (United States)

    ... Prenatal Baby Bathing & Skin Care Breastfeeding Crying & Colic Diapers & Clothing Feeding & Nutrition Preemie Sleep Teething & Tooth Care Toddler Preschool Gradeschool Teen Young Adult Healthy Children > Ages & Stages > Baby > Common Conditions in ...

  8. Medication as Infrastructure: Decentring Self-care

    Directory of Open Access Journals (Sweden)

    Peter Danholt

    2012-11-01

    Full Text Available Drawing on science and technology studies (STS, and specifically the concept of infrastructure as conceptualised by Bowker and Star (2000; Star 1999, this paper argues and empirically demonstrates that self-care may be considered a practice that is thoroughly sociotechnical, material, distributed and de-centred. Comparing the practices related to medication in the treatment of asthma, type 2 diabetes and haemophilia, we show that in practice there is no ‘self’ in self-care. More specifically, the ‘self’ in self-care is an actor who is highly dependent on, and intertwined with infrastructures of care, in order to be self-caring. Infrastructures of care are the more or less embedded ‘tracks’ along which care may ‘run’, shaping and being shaped by actors and settings along the way. Obtaining prescriptions, going to the pharmacy, bringing medication home and administering it as parts of daily life are commonplace activities embedded in the fabric of life, especially for those living with a chronic condition. However, this procurement and emplacement of medication involves the establishment and ongoing enactment of infrastructures of care, that is, the connections between various actors and locations that establish caring spaces and caring selves. Locations and actors are included as allies in treating chronic conditions outside the clinical setting, but these infrastructures may also be ambiguous, with respect to their effects; they may simultaneously contribute to the condition’s management and neglect. Particularly precarious is management at the fringes of healthcare infrastructure, where allies, routines and general predictability are scarce. We conclude by arguing that these insights may induce a greater sensitivity to existing infrastructures and practices, when seeking to introduce new infrastructures of care, such as those promoted under the headings of ‘telemedicine’ and ‘healthcare IT’.

  9. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    OpenAIRE

    Montaldo, N.; Toninelli, V.; Albertson, J. D.; Mancini, M.; P. A. Troch

    2003-01-01

    Recent developments have made land-surface models (LSMs) more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps), a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity) using the TOPLATS model, an ex...

  10. Using a Modified Soil-Plant-Atmosphere Scheme (MSPAS) to Study the Sensitivity of Land Surface and Boundary Layer Processes to Soil and Vegetation Conditions

    Institute of Scientific and Technical Information of China (English)

    刘树华; 乐旭; 刘辉志; 胡非

    2004-01-01

    A series of sensitivity tests are performed to test the stability and sensibility of the Modified Soil-PlantAtmosphere Scheme (MSPAS), which was wholly introduced in a previous paper. The numerical simulation results from the experiments show good agreement with physical reality. Besides, some of the results are illuminating. Together with the first paper, it is concluded that MSPAS is a simple but effective model,and it is practically valuable in the research work of desertification control and reforestation in China

  11. The prevalence and functional impact of musculoskeletal conditions amongst clients of a primary health care facility in an under-resourced area of Cape Town

    Directory of Open Access Journals (Sweden)

    Jelsma Jennifer

    2010-01-01

    Full Text Available Abstract Background The extent of disease burden of musculoskeletal conditions (MSC not due to injury has not been well determined in sub-Saharan Africa. The 1999 Global Burden of Disease study estimated the prevalence of osteoarthritis and rheumatoid arthritis to be 150/100,000 compared to 1,500/100,000 in Europe. The objective of the study was to determine the prevalence of MSC and the functional implications in a sample of people attending community health centres in Cape Town, South Africa. Methods A cross-sectional, descriptive study was conducted in clinics in two resource poor communities. Phase I consisted of screening and those who screened positive for peripheral or spinal joint pain went on to complete Phase II, which included the Stanford Health Assessment Questionnaire. Results 1005 people were screened in Phase I. Of these, 362 (36% reported MSC not due to injury in the past three months. Those with MSC had higher rates of co-morbidities in every category than those without. The mean Disability Index for those with MSC was mild to moderate and moderate to severe in those over 55 years. Conclusions Although the sample may not be representative of the general community, the prevalence is considerably greater than those reported elsewhere even when the population of the catchment area is used as a denominator, (367/100 000. The common presentation of MSC with co-morbid diabetes and hypertension requires holistic management by appropriately trained health care practitioners. Any new determination of burden of disease due to MSC should recognise that these disorders may be more prevalent in developing countries than previously estimated.

  12. Nitrogen-detected TROSY yields comparable sensitivity to proton-detected TROSY for non-deuterated, large proteins under physiological salt conditions

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Koh [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan); Arthanari, Haribabu [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Imai, Misaki [Japan Biological Informatics Consortium, Research and Development Department (Japan); Wagner, Gerhard, E-mail: gerhard-wagner@hms.harvard.edu [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Shimada, Ichio, E-mail: shimada@iw-nmr.f.u-tokyo.ac.jp [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan)

    2016-02-15

    Direct detection of the TROSY component of proton-attached {sup 15}N nuclei ({sup 15}N-detected TROSY) yields high quality spectra with high field magnets, by taking advantage of the slow {sup 15}N transverse relaxation. The slow transverse relaxation and narrow line width of the {sup 15}N-detected TROSY resonances are expected to compensate for the inherently low {sup 15}N sensitivity. However, the sensitivity of {sup 15}N-detected TROSY in a previous report was one-order of magnitude lower than in the conventional {sup 1}H-detected version. This could be due to the fact that the previous experiments were performed at low salt (0–50 mM), which is advantageous for {sup 1}H-detected experiments. Here, we show that the sensitivity gap between {sup 15}N and {sup 1}H becomes marginal for a non-deuterated, large protein (τ{sub c} = 35 ns) at a physiological salt concentration (200 mM). This effect is due to the high salt tolerance of the {sup 15}N-detected TROSY. Together with the previously reported benefits of the {sup 15}N-detected TROSY, our results provide further support for the significance of this experiment for structural studies of macromolecules when using high field magnets near and above 1 GHz.

  13. Urinary infection in patients of public health care of Campo Mourão-PR, Brazil: bacterial prevalence and sensitivity profile

    Directory of Open Access Journals (Sweden)

    Josiane dos Santos Bitencourt

    2014-10-01

    Full Text Available Introduction: Cases of bacterial resistance in urinary tract infections (UTIs have increased significantly, mainly due to indiscriminate use of antimicrobials. Objective: Objective: To evaluate the prevalence and antimicrobial susceptibility of microorganisms isolated in urine cultures of patients of Consórcio Intermunicipal de Saúde da Comunidade dos Municípios da Região de Campo Mourão (CISCOMCAM clinical laboratory. Method: We performed a retrospective study of data from urine culture and sensitivity done between January 2012 and December 2013. Results: The most prevalent bacteria were Escherichia coli; women were the most affected gender and people 16-45 years, the most affected age group. The sensitivity profile showed that the antimicrobial combination trimethoprim/ sulfamethoxazole was not associated with the highest rate of bacterial resistance (59.7% and the combination of amoxicillin/clavulanic acid showed the lowest resistance rate (15.3%. For most antimicrobials, including ciprofloxacin and norfloxacin, the rates of bacterial resistance have increased from 2012 to 2013 with statistical significance (p < 0.05 in some cases. Discussion: The prevalence of Gram-negative bacilli in urinary infections is due to the fact that intestinal flora is rich in enterobacteria, and women are most affected by anatomical factors. The development of bacterial resistance to antimicrobials probably arises from their indiscriminate use. Conclusion: The rate of microbial resistance has risen, showing the need for a more effective control of antimicrobial use.

  14. Progressive Care of Obese Patients.

    Science.gov (United States)

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  15. Cobalt sensitization and dermatitis

    DEFF Research Database (Denmark)

    Thyssen, Jacob P

    2012-01-01

    : This clinical review article presents clinical and scientific data on cobalt sensitization and dermatitis. It is concluded that cobalt despite being a strong sensitizer and a prevalent contact allergen to come up on patch testing should be regarded as a very complex metal to test with. Exposure...... data together with clinical data from metal workers heavily exposed to cobalt suggest that patch-test reactions are sometimes false positive and that patch testers should carefully evaluate their clinical relevance....

  16. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  17. Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit.

    Science.gov (United States)

    Layer, Franziska; Sanchini, Andrea; Strommenger, Birgit; Cuny, Christiane; Breier, Ann-Christin; Proquitté, Hans; Bührer, Christoph; Schenkel, Karl; Bätzing-Feigenbaum, Jörg; Greutelaers, Benedikt; Nübel, Ulrich; Gastmeier, Petra; Eckmanns, Tim; Werner, Guido

    2015-10-01

    Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.

  18. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G

    2007-07-01

    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  19. Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

    Directory of Open Access Journals (Sweden)

    Manuel Medell

    2012-02-01

    Full Text Available OBJECTIVE: This observational study described the characterization of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units. The demonstration of isolated microorganism resistance to antibiotics and a time-trend analysis of infection comparing a 48-month period were also other objectives. METHOD: Semi-quantitative assays of 1254 samples taken from 741 ventilated patients were performed, while pathogens were identified using the Enterotube II assay and VITEK 2 Compact equipment. Bacterial resistance to antibiotics was assessed by the Kirby-Bauer disc diffusion method and time-trend analysis of infection was based on data recorded by hospital microbiology laboratories. RESULTS: The most prevalent isolated bacteria from the patient's lower respiratory tract were with Gram-negative bacteria (67.8% mostly represented by: Acinetobacter spp. (25.2%, Pseudomonas spp. (18.3% and Klebsiellas spp. (9.4%. Acinetobacter spp. showed moderate high to very high resistance to ceftriaxone (CRO, gentamicin (CN, amikacin (AK, meropenem (MRP, aztreonam (ATM and piperacillin/tazobactam (TZP. Some isolates of Acinetobacter spp. resistant to colistin (CS were identified in this patient population. Pseudomonas spp. and Klebsiella spp. were very highly resistant to ampicillin/sublactam (AMS and with moderate or low resistance to CRO, ATM, MRP, AK, CN and TZP. A decrease in the Pseudomonas spp. prevalence rate was observed, whereas an increase in Acinetobacter spp. and Klebsiella spp. prevalence rates were observed in a 48-month period. CONCLUSION: This research corroborated that these nosocomial infections are a relevant medical problem in our context. The most prevalent bacterial infections in the lower respiratory tract of ventilated patients were by Acinetobacter spp., Pseudomonas spp. and Klebsiella spp. The panel of antibiotics used as preventive therapy was not the solution of infections and probably induced

  20. High-sensitivity nuclear magnetic resonance at Giga-Pascal pressures: a new tool for probing electronic and chemical properties of condensed matter under extreme conditions.

    Science.gov (United States)

    Meier, Thomas; Haase, Jürgen

    2014-01-01

    Nuclear Magnetic Resonance (NMR) is one of the most important techniques for the study of condensed matter systems, their chemical structure, and their electronic properties. The application of high pressure enables one to synthesize new materials, but the response of known materials to high pressure is a very useful tool for studying their electronic structure and developing theories. For example, high-pressure synthesis might be at the origin of life; and understanding the behavior of small molecules under extreme pressure will tell us more about fundamental processes in our universe. It is no wonder that there has always been great interest in having NMR available at high pressures. Unfortunately, the desired pressures are often well into the Giga-Pascal (GPa) range and require special anvil cell devices where only very small, secluded volumes are available. This has restricted the use of NMR almost entirely in the past, and only recently, a new approach to high-sensitivity GPa NMR, which has a resonating micro-coil inside the sample chamber, was put forward. This approach enables us to achieve high sensitivity with experiments that bring the power of NMR to Giga-Pascal pressure condensed matter research. First applications, the detection of a topological electronic transition in ordinary aluminum metal and the closing of the pseudo-gap in high-temperature superconductivity, show the power of such an approach. Meanwhile, the range of achievable pressures was increased tremendously with a new generation of anvil cells (up to 10.1 GPa), that fit standard-bore NMR magnets. This approach might become a new, important tool for the investigation of many condensed matter systems, in chemistry, geochemistry, and in physics, since we can now watch structural changes with the eyes of a very versatile probe. PMID:25350694

  1. A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

    Directory of Open Access Journals (Sweden)

    Bower Peter

    2012-01-01

    Full Text Available Abstract Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD, and irritable bowel syndrome (IBS. The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. Trial registration number ISRCTN: ISRCTN90940049

  2. Sensitivity of Eisenia andrei (Annelida, Oligochaeta) to a commercial formulation of abamectin in avoidance tests with artificial substrate and natural soil under tropical conditions.

    Science.gov (United States)

    Nunes, Maria Edna Tenório; Espíndola, Evaldo Luiz Gaeta

    2012-05-01

    Obtaining ecotoxicological data on pesticides in tropical regions is imperative for performing more realistic risk analysis, and avoidance tests have been proposed as a useful, fast and cost-effective tool. Therefore, the present study aimed to evaluate the avoidance behavior of Eisenia andrei to a formulated product, Vertimec® 18 EC (a.i abamectin), in tests performed on a reference tropical artificial soil (TAS), to derive ecotoxicological data on tropical conditions, and a natural soil (NS), simulating crop field conditions. In TAS tests an adaptation of the substrate recommended by OECD and ISO protocols was used, with residues of coconut fiber as a source of organic matter. Concentrations of the pesticide on TAS test ranged from 0 to 7 mg abamectin/kg (dry weight-d.w.). In NS tests, earthworms were exposed to samples of soils sprayed in situ with: 0.9 L of Vertimec® 18 EC/ha (RD); twice as much this dosage (2RD); and distilled water (Control), respectively, and to 2RD: control dilutions (12.5, 25, 50, 75%). All tests were performed under 25 ± 2°C, to simulate tropical conditions, and a 12hL:12hD photoperiod. The organisms avoided contaminated TAS for an EC(50,48h) = 3.918 mg/kg soil d.w., LOEC = 1.75 mg/kg soil d.w. and NOEC = 0.85 mg/kg soil d.w. No significant avoidance response occurred for any NS test. Abamectin concentrations in NS were rather lower than EC(50, 48h) and LOEC determined in TAS tests. The results obtained contribute to overcome a lack of ecotoxicological data on pesticides under tropical conditions, but more tests with different soil invertebrates are needed to improve pesticides risk analysis. PMID:22297724

  3. Supplementing five-point body condition score with body fat percentage increases the sensitivity for assessing overweight status of small to medium sized dogs

    OpenAIRE

    ARAI, Toshiro

    2012-01-01

    Gebin Li,1 Peter Lee,1 Nobuko Mori,1 Ichiro Yamamoto,1 Koh Kawasumi,1 Hisao Tanabe,2 Toshiro Arai11Department of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 2Komazawa Animal Hospital, Tokyo, JapanBackground and methods: Currently, five-point body condition scoring (BCS) is widely used by veterinarians and clinicians to assess adiposity in dogs in Japan. However, BCS score assignment is subjective in nature, and most clinicians do not score...

  4. Risk-factors for stress-related absence among health care employees: a bio-psychosocial perspective. Associations between self-rated health, working conditions and biological stress hormones

    Directory of Open Access Journals (Sweden)

    Ann-Sophie Hansson

    2006-12-01

    Full Text Available

    Background: Stress is a major cause of sickness absence and the health care sector appears to be especially at risk. This cross sectional study aimed to identify the risk factors for absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on presence or not of self-rated sickness absence for stress. Questionnaire data and stress sensitive hormones measurements were used.

    Results: Employees with stress related sick leave experienced worse health, poorer work satisfaction as well as worse social and home situations than those employees without stress-related sick leave. No-significant differences were identified regarding stress-sensitive hormones. The risk for employees, not satisfied at work, of becoming absent due to stress was approximately three fold compared to those who reported being satisfied (OR 2.8, 95% confidence interval; (CI 1.3 - 5.9. For those not satisfied with their social situation, the risk for sickness absence appeared to be somewhat higher (OR 3.2; CI 1.2 - 8.6. Individual factors such as recovery potential and meaning of life as well as work related factors such as skill development and work tempo predicted employee’ s work satisfaction.

    Conclusions: Based on cross sectional data, work-site and individual factors as well as social situations appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and poor leadership appeared to be related to the high degree of work related exhaustion experienced by employees.

  5. High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care

    Directory of Open Access Journals (Sweden)

    Bergenzaun Lill

    2012-09-01

    Full Text Available Abstract Background Left ventricular (LV dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. Methods A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP, high-sensitive troponin T (hsTNT and transthoracic echocardiography (TTE were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF, mean atrioventricular plane displacement (AVPDm, peak systolic tissue Doppler velocity imaging (TDIs and velocity time integral in the LV outflow tract (LVOT VTI. LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time, tissue Doppler indices (é, á, E/é and left atrial volume (La volume. APACHE II (Acute Physiology and Chronic Health Evaluation and SOFA (Sequential Organ Failure Assessment scores were calculated. Results hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003. Other univariate predictors of mortality were APACHE II (p = 0.009, E/é (p = 0.023, SOFA (p = 0.024 and age (p = 0.031. Survivors and non-survivors did not differ regarding BNP (p = 0.26 or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18. Multivariable logistic regression analysis identified hsTNT (p = 0.010 as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5. Conclusions hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

  6. Persistent and non-persistent strains of Listeria monocytogenes: A focus on growth kinetics under different temperature, salt, and pH conditions and their sensitivity to sanitizers.

    Science.gov (United States)

    Magalhães, R; Ferreira, V; Brandão, T R S; Palencia, R Casquete; Almeida, G; Teixeira, P

    2016-08-01

    This study aimed to investigate the effect of different conditions, including temperature (37 °C, 22 °C, and 4 °C), NaCl concentrations (2.5%, 4%, and 8%), and acidity (pH = 5), on the growth response of persistent and non-persistent isolates of Listeria monocytogenes. The resistance to two common sanitizers (benzalkonium chloride and hydrogen peroxide) was also investigated. A selected group of 41 persistent and non-persistent L. monocytogenes isolates recovered from three cheese processing plants during a previous longitudinal study was assembled. Average lag time was similar for persistent and non-persistent isolates grown at 37 °C, 22 °C and 4 °C but significantly shorter (p < 0.05) for persistent isolates grown at 2.5%, 4% and 8% NaCl, and at pH 5. Average growth rates were significantly higher (p < 0.05) for persistent than for non-persistent isolates when grown at 22 °C, 2.5%, 4% and 8% NaCl, and at pH 5. These results suggest that persistent strains may be better adapted to grow under stressful conditions frequently encountered in food processing environments than non-persistent strains. No relation between persistence and resistance to the tested sanitizers was found. PMID:27052708

  7. Influence of Desorption Conditions on Analyte Sensitivity and Internal Energy in Discrete Tissue or Whole Body Imaging by IR-MALDESI

    Science.gov (United States)

    Rosen, Elias P.; Bokhart, Mark T.; Ghashghaei, H. Troy; Muddiman, David C.

    2015-06-01

    Analyte signal in a laser desorption/postionization scheme such as infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) is strongly coupled to the degree of overlap between the desorbed plume of neutral material from a sample and an orthogonal electrospray. In this work, we systematically examine the effect of desorption conditions on IR-MALDESI response to pharmaceutical drugs and endogenous lipids in biological tissue using a design of experiments approach. Optimized desorption conditions have then been used to conduct an untargeted lipidomic analysis of whole body sagittal sections of neonate mouse. IR-MALDESI response to a wide range of lipid classes has been demonstrated, with enhanced lipid coverage received by varying the laser wavelength used for mass spectrometry imaging (MSI). Targeted MS2 imaging (MS2I) of an analyte, cocaine, deposited beneath whole body sections allowed determination of tissue-specific ion response factors, and CID fragments of cocaine were monitored to comment on wavelength-dependent internal energy deposition based on the "survival yield" method.

  8. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

    Science.gov (United States)

    Emerson, Natacha D.; Morrell, Holly E. R.; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent…

  9. Multiple chemical sensitivity

    DEFF Research Database (Denmark)

    Tran, Marie Thi Dao; Arendt-Nielsen, Lars; Kupers, Ron;

    2013-01-01

    BACKGROUND: Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by recurrent, non-specific symptoms in response to chemically unrelated exposures in non-toxic concentrations. Although the pathophysiology of MCS remains unknown, central sensitization may be an important factor...

  10. Development, validation and application of a sensitive analytical method for residue determination and dissipation of imidacloprid in sugarcane under tropical field condition.

    Science.gov (United States)

    Ramasubramanian, T; Paramasivam, M; Nirmala, R

    2016-06-01

    A simple and sensitive analytical method has been developed and validated for the determination of trace amounts of imidacloprid in/on sugarcane sett, stalk and leaf. The method optimized in the present study requires less volume of organic solvent and time. Hence, this method is suitable for high-throughput analyses involving large number of samples. The limit of detection (LOD) and limit of quantification (LOQ) of the method were 0.003 and 0.01 mg/kg, respectively. The recovery and relative standard deviation were more than 93 % and less than 4 %, respectively. Thus, it is obvious that the analytical method standardized in this study is more precise and accurate enough to determine the residues of imidacloprid in sugarcane sett, stalk and leaf. The dissipation and translocation of imidacloprid residues from treated cane setts to leaf and stalk were studied by adopting this method. In sugarcane setts, the residues of imidacloprid persisted up to 120 days with half-life of 15.4 days at its recommended dose (70 g a.i./ha). The residues of imidacloprid were found to be translocated from setts to stalk and leaf. The imidacloprid residues were detected up to 105 days in both leaf and stalk. Dipping of sugarcane setts in imidacloprid at its recommended dose may result in better protection of cane setts and established crop because of higher initial deposit (>100 mg/kg) and longer persistence (>120 days). PMID:27230427

  11. Diverticular Disease in the Primary Care Setting.

    Science.gov (United States)

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-10-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases. PMID:27622376

  12. Sensitivity analysis

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003741.htm Sensitivity analysis To use the sharing features on this page, please enable JavaScript. Sensitivity analysis determines the effectiveness of antibiotics against microorganisms (germs) ...

  13. Sensitivity to initial conditions of a d-dimensional long-range-interacting quartic Fermi-Pasta-Ulam model: Universal scaling.

    Science.gov (United States)

    Bagchi, Debarshee; Tsallis, Constantino

    2016-06-01

    We introduce a generalized d-dimensional Fermi-Pasta-Ulam model in the presence of long-range interactions, and perform a first-principle study of its chaos for d=1,2,3 through large-scale numerical simulations. The nonlinear interaction is assumed to decay algebraically as d_{ij}^{-α} (α≥0), {d_{ij}} being the distances between N oscillator sites. Starting from random initial conditions we compute the maximal Lyapunov exponent λ_{max} as a function of N. Our N≫1 results strongly indicate that λ_{max} remains constant and positive for α/d>1 (implying strong chaos, mixing, and ergodicity), and that it vanishes like N^{-κ} for 0≤α/dunity, it monotonically decreases from unity to zero, remaining so for all α/d>1. The value α/d=1 can therefore be seen as a critical point separating the ergodic regime from the anomalous one, κ playing a role analogous to that of an order parameter. This scaling law is consistent with Boltzmann-Gibbs statistics for α/d>1, and possibly with q statistics for 0≤α/d<1. PMID:27415261

  14. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity.

    Science.gov (United States)

    Emerson, Natacha D; Morrell, Holly E R; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children. PMID:26280401

  15. Bioconcentration of two pharmaceuticals (benzodiazepines) and two personal care products (UV filters) in marine mussels (Mytilus galloprovincialis) under controlled laboratory conditions

    OpenAIRE

    Gomez, E; Bachelot, M.; Boillot, C.; Munaron, D.; Chiron, Serge; Casellas, C; Fenet, H.

    2012-01-01

    Bioaccumulation is essential for gaining insight into the impact of exposure to organic micropollutants in aquatic fauna. Data are currently available on the bioaccumulation of persistent organic pollutants, but there is very little documentation on the bioaccumulation of pharmaceuticals and personal care products (PPCPs). The bioconcentration of selected PPCPs was studied in marine mussels (Mytilus galloprovincialis). The selected PPCPs were two organic UV filters, i.e., 2-ethylhexyl-4-trime...

  16. Freqüência à creche e outros condicionantes do estado nutricional infantil Attendance at day-care centers and other conditioning factors in child nutritional status

    Directory of Open Access Journals (Sweden)

    Marina Vieira da Silva

    1998-06-01

    Full Text Available O estudo descreve o estado nutricional de 2 096 pré-escolares atendidos nos 27 Centros Educacionais e Creches do município de Piracicaba, estado de São Paulo. Observa-se que 5,1% das crianças apresentam déficit de altura/idade (escore ZAI The study describes the nutritional status of 2 096 preschool children attending 27 Educational Centers and Day-Care Centers in Piracicaba, state of São Paulo. Five point one percent of the children are observed to present a height/age deficit (score HAZ<-2.0 and a proportion of 1.2 with weight/height deficit (score WHZ<-2.0. The results reveal that per capita income, mother schooling, type of sewage, type of housing and attendance time at are the variables that cause impact on the HAZ score of the children.The positive association detected between attendance time at and -Z score of height for age stresses the importance of these investments as means to protect children, mainly against chronic malnutrition, as basic care with health, feeding and hygiene is associated with education. The day-care center also provides the participation of mothers in the work market, which is very important in poor families in order to increase family income.

  17. Preparing the Pediatric Dentist for Palliative and End-of-life Care.

    Science.gov (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M

    2016-01-01

    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions.

  18. Preparing the Pediatric Dentist for Palliative and End-of-life Care.

    Science.gov (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M

    2016-01-01

    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions. PMID:27557917

  19. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH)

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals” (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care. PMID:26958457

  20. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  1. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care. PMID:26958457

  2. Estado de salud y utilización de recursos sanitarios de una población de ancianos atendidos en domicilio Health conditions and use of social care resources in a population of the elderly taken care at home

    Directory of Open Access Journals (Sweden)

    Carmen Gálvez-Romero

    2007-09-01

    Full Text Available La población de personas mayores, respecto a la población general en España, representa un 15,4%, proporción que aumentará en el futuro, sobre todo en mayores de 80 años. La atención domiciliaria de esta población es alternativa a su institucionalización, por lo que interesa conocer sus características sociodemográficas, clínicas y de utilización de recursos sanitarios para responder a sus necesidades reales. Se realizó un estudio de corte transversal en pacientes incluidos en un programa de incapacitados. Se estudiaron variables sociodemográficas y clínicas, capacidad funcional y cognitiva, y utilización de recursos sociosanitarios. Nuestros pacientes son una población mayor, presentan deterioro cognitivo importante, nivel elevado de dependencia y comorbilidad. Una quinta parte considera su estado de salud como malo. Utilizan con frecuencia los servicios de urgencia y, en menor medida, ingresan en el hospital. Algunas características sociodemográficas de estos pacientes determinan su nivel de audición y estado mental, tales como la edad, ocupación en su etapa laboral e ingresos económicos. Se mostraron determinantes de la utilización de los servicios sanitarios las patologías crónicas, la polifarmacia, escasamente las incapacidades funcionales y los ingresos económicos.Older persons represent 15,4% of the population of Spain. This proportion will increase in the future, especially for persons older than 80 years of age. As home care for this population is an alternative to their institutionalization, it is necessary to determine their sociodemographic and clinical characteristics, as well as their use of health care resources, in order to respond to their true needs. We undertook a cross-sectional study of patients included in an Incapacity Program. Variables studied included sociodemographic and clinical factors, functional and cognitive capacity, and the use of health and social care resources. The patients were

  3. Working conditions, health and productivity among dentists in Swedish public dental care - a prospective study during a 5-year period of rationalisation

    DEFF Research Database (Denmark)

    Rolander, B.; Jonker, D.; Winkel, Jørgen;

    2013-01-01

    In recent decades, comprehensive rationalisations have been implemented in public dentistry in Sweden. How rationalisations affect working conditions, health and production from a long-term perspective has been poorly investigated. This study aims to analyse changes and associations in dentists......' working conditions, health and productivity during a 5-year period. In 2003 and 2008, 65 dentists responded to questionnaires measuring work conditions and health. Treatment times for patients and productivity were tracked in electronic registers. Paired t-tests showed that the number of treated adult...... patients per dentist increased, and perceived physical working conditions improved while perceived work control and leadership deteriorated. Structural equation modelling showed that physical factors were important for health and productivity. When assessing risks in the work environment, there is a need...

  4. 神经内科重症监护病房病原菌分布及药敏分析%Characteristic Description and Drug Sensitivity Testing of Pathogenic Bacteria in Neurological Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    李海英; 李淑娟; 胡文立; 秦伟

    2011-01-01

    Objective The characteristic of infection strains and the changes in antibiotic-resistance in neurological intensive care unit(NICU) were investigated to direct the antibiotics clinical application, and to reduce the hospital infection incidence rates. Methods From Sep. 2008 to May 2010,451 species from 216 patients in N1CU, including sputum, urine, stools, and blood, were cultured for bacteria identification and drug sensitivity testing. Results Among the isolated 399 strains of pathogenic bacteria,Gram-negative bacilli,Gram-positive cocci and fungi, were 140,73 and 186, respectively. The pathogens were mainly from respiratory tract. As the major pathogens, Candida albicans and Staphylococcus aureu accounted for 49.9% of all pathogens. The results of drug sensitivity testing showed that fungi had great clinical drug resistance; MRSA showed high sensitivity to Glyco-peptides-type drugs;and Gram-negative bacilli showed sensitivity to Carbapenem-type drugs. Cephalosporin-type and Penicillin-type drugs showed different sensitivities to the Gram-negative bacilli. Conclusion The main pathogenic bacteria of NICU were fungi and Gram-negative bacilli, which might be the contribution of extensive use of broad-spectrum antibiotics. The doctors should pay attention to reduce the use of broad-spectrum antibiotics,appropriately increase the use of Glycopeptides-type and Carbapenem-type drugs. Cefoperazone/sulbactam or ceftazidime was suggested as the conventional antiseptic drug.%目的 调查神经内科重症监护病房(NICU)感染患者的病原菌分布及耐药情况,以指导临床抗菌药物的应用,降低医院感染率.方法 对2008年9月-2010年5月期间入住NICU的216例患者送检的痰、尿、便、血等451份标本进行病原菌鉴定和体外药敏试验.结果检出的399株病原菌中,G-杆菌140株,G+球菌73株,真菌186株.病原菌主要采自于呼吸道.致病菌简单且集中,白色念珠菌和MRSA占所有致病菌的49.9%.药敏结果

  5. Sensitivity analysis

    International Nuclear Information System (INIS)

    General remarks on sensitivity analysis, the study of changes in a model output produced by varying model inputs, are made first. Sampling methods are discussed, and three sensitivity measures: partial rank correlation, derivative or response surface, and partial variance are described. Some sample results for a 16-input, 13-output hydrodynamics model are given. Both agreement and disagreement were found among the sensitivity measures. 4 figures

  6. Abscisic Acid and Cytokinin-Induced Osmotic and Antioxidant Regulation in Two Drought-Tolerant and Drought-Sensitive Cultivars of Wheat During Grain Filling Under Water Deficit in Field Conditions

    Directory of Open Access Journals (Sweden)

    Mohammad-Reza SARAFRAZ-ARDAKANI

    2014-09-01

    Full Text Available Phytohormones play critical roles in regulating plant responses to stress. The present study investigates the effect of cytokinin, abscisic acid and cytokinin/abscisic acid interaction on some osmoprotectants and antioxidant parameters induced by drought stress in two wheat cultivars (Triticum aestivum L. of ‘Pishgam’ and ‘MV-17’ as tolerant and sensitive to drought during post-anthesis phase, respectively grown in field conditions. The most considerable effect of the treatments was exhibited 21 days after anthesis. Under drought conditions, the flag leaf soluble carbohydrate content increased in both cultivars while starch content was remarkably decreased in ‘Pishgam’ as compared to ‘MV-17’. Abscisic acid increased total soluble sugar and reduced starch more than other hormonal treatments, although it decreased studied monosaccharaides in ‘Pishgam’, especially. Drought stress induced high proportion of gylycinebetain and free proline in ‘Pishgam’ cultivar. Application of abscisic acid and cytokinin/abscisic acid interaction increased gylycinebetain and proline content in both cultivars under irrigation and drought conditions. The tolerant cultivar exhibited less accumulation of hydrogen peroxide and malondialdehyde in relation to significant increase of catalase and peroxidase activities and α-tocpherol content under drought conditions. All hormonal treatments increased the named enzyme activities under both irrigation and drought conditions, while higher accumulation of α-tocopherol was only showed in case of cytokinin application. Also, abscisic acid and cytokinin/abscisic acid could decrease drought-induced hydrogen peroxide and malondialdehyde level to some extent, although abscisic acid increased both of hydrogen peroxide andmalondialdehyde content in irrigation phase, especially.

  7. Child Care Centres.

    Science.gov (United States)

    Australian Dept. of Labour and National Service, Melbourne. Women's Bureau.

    Based on a survey of legislation relating to full-day care for preschool children of working mothers and a study of records, this report: (1) covers the number of registered child care centers in Australia and the number of children being served, (2) sets the conditions applying to registration of centers, (3) indicates the extent and levels of…

  8. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  9. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  10. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  11. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  12. Skin Care and Aging

    Science.gov (United States)

    ... page please turn Javascript on. Skin Care and Aging How Aging Affects Skin Your skin changes with age. It ... if they bother you. See additional resources on aging skin, including information on treatment options, specific conditions, ...

  13. Condition of mycoplasma infection of genitourinary tract and drug sensitive tests%泌尿生殖道支原体感染情况及药敏分析

    Institute of Scientific and Technical Information of China (English)

    刘宏; 李静; 王艳新; 张欣

    2011-01-01

    目的 了解本地区支原体在人类泌尿生殖系统的感染及药敏情况,指导临床合理用药.方法 采用支原体培养及药敏试剂盒对420例泌尿生殖道感染患者进行支原体培养和鉴定,并进行了12种常用抗生素的药敏试验.结果 420例泌尿生殖道感染患者中,支原体阳性205例,阳性率为48.8%,其中女性感染率(66.5%)高于男性感染率(30.2%)(P<0.05).解脲支原体(Uu)、人型支原体(Mh)、混合(Uu+Mh)感染率分别为29.8%、0.7%、18.3%;药敏结果显示支原体对美满霉素和强力霉素敏感性较高.结论 美满霉素和强力霉素可作为目前本地区治疗泌尿生殖道感染的首选药物.%Objective To understand the conditions of genitourinary system mycoplasma infection and drug sensitivity and provide rational administration for clinical practice. Methods The mycoplasma was cultured and identified by mycoplasma culture and identification kits in 420 cases with urinary genital tract mycoplasma infection and the sensitivity of mycoplasma to 12 antibacterials were tested. Results In 420 suspected cases,positive rate of mycoplasma was 48. 8% (205 cases) ,and the female infection rate(66. 5% ) was significantly higher than that of male(30.2% )(P<0.05). The Ureaplasma urealytic-um( Uu) ,Mycoplasma homins( Mh) and Uu + Mh infection rates were 29. 8% ,0. 7% , 18. 3% respectively. The sensitive tests showed that the mycoplasma had higher sensitivity to minocycline and deoxycycline. Conclusion The minocycline and deoxycycline can be used as the first choice drug for treatment genitourinary tract mycoplasma infection.

  14. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care survey

    OpenAIRE

    Okunseri C; Okunseri E; Fischer MC; Sadeghi SN; Xiang Q; Szabo A

    2013-01-01

    Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC)-related emergency department (ED) visits are higher during the typical working hours of dental o...

  15. Gluten Sensitivity

    Science.gov (United States)

    Gluten is a protein found in wheat, rye, and barley. It is found mainly in foods but ... products like medicines, vitamins, and supplements. People with gluten sensitivity have problems with gluten. It is different ...

  16. Climate sensitivity

    OpenAIRE

    Roy THOMPSON

    2015-01-01

    Earth has been habitable through most of its history, but the anthropogenically mediated greenhouse effect, if sufficiently strong, can threaten Earth's long-standing equability. This paper's main aim is to determine the strength of the anthropogenic greenhouse effect (the climate sensitivity) from observational data and basic physics alone, without recourse to the parameterisations of earth-system models and their inevitable uncertainties. A key finding is that the sensitivity can be constra...

  17. Cues of maternal condition influence offspring selfishness.

    Directory of Open Access Journals (Sweden)

    Janine W Y Wong

    Full Text Available The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism and extracted and analyzed the females' cuticular hydrocarbons (CHC. Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons.

  18. Cues of maternal condition influence offspring selfishness.

    Science.gov (United States)

    Wong, Janine W Y; Lucas, Christophe; Kölliker, Mathias

    2014-01-01

    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females' cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  19. Nursing Care of Women Who Have Undergone Genital Cutting.

    Science.gov (United States)

    Tilley, Donna Scott

    2015-01-01

    Female genital cutting (FGC), commonly called female genital mutilation, affects millions of women but is poorly understood by many health care providers. FGC procedures intentionally alter the female genital organs for nonmedical reasons and include partial or total removal of female genital organs. These procedures, which have no medical value, are usually done between birth and puberty. Health consequences vary in severity but can be devastating. Women who have experienced FGC may be reluctant to seek health care or to disclose their condition to providers. Suggestions for culturally competent care of women who have experienced FGC are outlined, focusing on understanding the cultural beliefs and values of women who have undergone these procedures and providing informed and sensitive care. PMID:26460917

  20. Bioconcentration of two pharmaceuticals (benzodiazepines) and two personal care products (UV filters) in marine mussels (Mytilus galloprovincialis) under controlled laboratory conditions.

    Science.gov (United States)

    Gomez, Elena; Bachelot, Morgane; Boillot, Clotilde; Munaron, Dominique; Chiron, Serge; Casellas, Claude; Fenet, Hélène

    2011-08-01

    Bioaccumulation is essential for gaining insight into the impact of exposure to organic micropollutants in aquatic fauna. Data are currently available on the bioaccumulation of persistent organic pollutants, but there is very little documentation on the bioaccumulation of pharmaceuticals and personal care products (PPCPs). The bioconcentration of selected PPCPs was studied in marine mussels (Mytilus galloprovincialis). The selected PPCPs were two organic UV filters, i.e., 2-ethylhexyl-4-trimethoxycinnamate (EHMC) and octocrylene (OC), and two benzodiazepines (BZP), i.e., diazepam (DZP) and tetrazepam (TZP). Laboratory experiments were performed in which M. galloprovincialis was exposed to these compounds either directly from water, for the less lipophilic substances (BZP) or via spiked food for lipophilic UV filters. M. galloprovincialis uptook and eliminated BZP following first-order kinetics. The biological half-life (t (1/2)) of TZP was 1.4 days, resulting in a bioconcentration factor of 64 and 99 mL g(-1) dry weight (dw), respectively, for 2.3 and 14.5 μg L(-1) of exposure, while the biological half-life (t (1/2)) of DZP was 0.4 days, resulting in a bioconcentration factor of 51 mL g(-1) dw for 13.2 μg L(-1) of exposure. The uptake of UV filter was rapid in mussels, followed by elimination within 24 h. EHMC increased from 15 to 138 ng g(-1) dw in 1 h and decreased to 25 ng g(-1) after 24 h for 11.9 μg L(-1) exposure. OC reached 839 ng g(-1) dw after 1 h and decreased to 33 ng g(-1) after 24 h for 11.6 μg L(-1) exposure. However, EHMC and OC were slightly accumulated in 48 h, i.e., 38 and 60 ng g(-1) dw, respectively. PMID:22828885

  1. These Shoes Are Made for Walking: Sensitivity Performance Evaluation of Commercial Activity Monitors under the Expected Conditions and Circumstances Required to Achieve the International Daily Step Goal of 10,000 Steps.

    Directory of Open Access Journals (Sweden)

    Sandra O'Connell

    Full Text Available Physical activity is a vitally important part of a healthy lifestyle, and is of major benefit to both physical and mental health. A daily step count of 10,000 steps is recommended globally to achieve an appropriate level of physical activity. Accurate quantification of physical activity during conditions reflecting those needed to achieve the recommended daily step count of 10,000 steps is essential. As such, we aimed to assess four commercial activity monitors for their sensitivity/accuracy in a prescribed walking route that reflects a range of surfaces that would typically be used to achieve the recommended daily step count, in two types of footwear expected to be used throughout the day when aiming to achieve the recommended daily step count, and in a timeframe required to do so.Four commercial activity monitors were worn simultaneously by participants (n = 15 during a prescribed walking route reflective of surfaces typically encountered while achieving the daily recommended 10,000 steps. Activity monitors tested were the Garmin Vivofit ™, New Lifestyles' NL-2000 ™ pedometer, Withings Smart Activity Monitor Tracker (Pulse O2 ™, and Fitbit One ™.All activity monitors tested were accurate in their step detection over the variety of different surfaces tested (natural lawn grass, gravel, ceramic tile, tarmacadam/asphalt, linoleum, when wearing both running shoes and hard-soled dress shoes.All activity monitors tested were accurate in their step detection sensitivity and are valid monitors for physical activity quantification over the variety of different surfaces tested, when wearing both running shoes and hard-soled dress shoes, and over a timeframe necessary for accumulating the recommended daily step count of 10,000 steps. However, it is important to consider the accuracy of activity monitors, particularly when physical activity in the form of stepping activities is prescribed as an intervention in the treatment or prevention of a

  2. Maternal perception regarding child care and development

    Directory of Open Access Journals (Sweden)

    Mirna Albuquerque Frota

    2011-09-01

    Full Text Available Objective: To investigate the perception of mothers regarding the care and development of their children. Methods: This was a descriptive and qualitative study, conducted in a Basic Health Unit (UBS in Fortaleza-CE, Brazil, in the period from July to October, 2008. The subjects were twenty mothers who accompanied their children in childcare consultation and met with favorable clinical conditions. Data collection techniques used free observation and semistructured interview consisting of questions involving the perception of child development and care. Results: By means of data analysis the following categories emerged: “Smile and play: mother’s perception regarding the development of the child”; “Take care: emphasis on breastfeeding and body hygiene”. The main source of nonverbal communication that the child has to convey affection and love is the smile, being an essential activity to child development. We verified that the care with breastfeeding and body hygiene suggest behavioral indicators of maternal sensitivity. Final considerations: The childcare consultation held in UBS is essential, because it allows integration of ideas and actions shared with the professional-parent dyad, thus providing the arousal of new experiences in care and the influence on child development.

  3. Path Sensitization

    Institute of Scientific and Technical Information of China (English)

    赵著行; 闵应骅; 等

    1997-01-01

    For different delay models,the concept of sensitization can be very different.Traditonal concepts of sensitization cannot precisely describe circuit behavior when the input vectors change very fast.Using Boolean process aporoach,this paper presents a new definition of sensitization for arbitrary input waveforms.By this new concept it is found that if the inputs of a combinational circuit can change at any time,and each gate's delay varies within an interval (bounded gate delay model),then every path,which is not necessarily a single topological path,is sensitizable.From the experimental results it can be seen that,all nonsensitizable paths for traditional concepts actually can propagate transitions along them for some input waveforms.However,specified time between input transitions(STBIT) and minimum permissible pulse width(ε)are two major factors to make some paths non-sensitizable.

  4. Sensitivity of Complex Networks

    CERN Document Server

    Angulo, Marco Tulio; Liu, Yang-Yu; Barabási, Albert-László

    2016-01-01

    The sensitivity (i.e. dynamic response) of complex networked systems has not been well understood, making difficult to predict whether new macroscopic dynamic behavior will emerge even if we know exactly how individual nodes behave and how they are coupled. Here we build a framework to quantify the sensitivity of complex networked system of coupled dynamic units. We characterize necessary and sufficient conditions for the emergence of new macroscopic dynamic behavior in the thermodynamic limit. We prove that these conditions are satisfied only for architectures with power-law degree distributions. Surprisingly, we find that highly connected nodes (i.e. hubs) only dominate the sensitivity of the network up to certain critical frequency.

  5. Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India

    Directory of Open Access Journals (Sweden)

    Purnima Madhivanan

    2013-01-01

    Full Text Available Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+ intervention of community mobilization strategy providing conditional cash transfers (CCT to women’s SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3% women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5% received ANC in the SCIL+ arm (P<0.001; 175 (97% in the SCIL and 366 (98.6% in the SCIL+ arm consented to HIV testing (P<0.001. HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women’s microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages.

  6. Beyond Care Avoidance and Care Paralysis : Theorizing Public Mental Health Care

    NARCIS (Netherlands)

    Schout, Gert; de Jong, Gideon; Zeelen, Jacques

    2011-01-01

    Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in

  7. The glucagon-like peptide 1 analogue Exendin-4 attenuates the nicotine-induced locomotor stimulation, accumbal dopamine release, conditioned place preference as well as the expression of locomotor sensitization in mice.

    Directory of Open Access Journals (Sweden)

    Emil Egecioglu

    Full Text Available The gastrointestinal peptide glucagon-like peptide 1 (GLP-1 is known to regulate consummatory behavior and is released in response to nutrient ingestion. Analogues of this peptide recently emerged as novel pharmacotherapies for treatment of type II diabetes since they reduce gastric emptying, glucagon secretion as well as enhance glucose-dependent insulin secretion. The findings that GLP-1 targets reward related areas including mesolimbic dopamine areas indicate that the physiological role of GLP-1 extends beyond food intake and glucose homeostasis control to include reward regulation. The present series of experiments was therefore designed to investigate the effects of the GLP-1 receptor agonist, Exendin-4 (Ex4, on established nicotine-induced effects on the mesolimbic dopamine system in mice. Specifically, we show that treatment with Ex4, at a dose with no effect per se, attenuate nicotine-induced locomotor stimulation, accumbal dopamine release as well as the expression of conditioned place preference in mice. In accordance, Ex4 also blocks nicotine-induced expression of locomotor sensitization in mice. Given that development of nicotine addiction largely depends on the effects of nicotine on the mesolimbic dopamine system these findings indicate that the GLP-1 receptor may be a potential target for the development of novel treatment strategies for nicotine cessations in humans.

  8. Sensitive innovation

    DEFF Research Database (Denmark)

    Søndergaard, Katia Dupret

    definition developed by Schumpeter that defines innovation as an effort by one or more individuals to create economic profit through a qualitative change by Schumpeter in 1934). These different lines are to do with acknowledging how innovative sources are heterogenic and intangible. Also, it is argued......Present paper discusses sources of innovation as heterogenic and at times intangible processes. Arguing for heterogeneity and intangibility as sources of innovation originates from a theoretical reading in STS and ANT studies (e.g. Callon 1986, Latour 1996, Mol 2002, Pols 2005) and from field work...... in the area of mental health (Dupret Søndergaard 2009, 2010). The concept of sensitive innovation is developed to capture and conceptualise exactly those heterogenic and intangible processes. Sensitive innovation is therefore primarily a way to understand innovative sources that can be...

  9. A Primer of Covert Sensitization

    Science.gov (United States)

    Kearney, Albert J.

    2006-01-01

    Covert sensitization is the first of a family of behavior therapy procedures called covert conditioning initially developed by Joseph Cautela in the 1960s and 1970s. The covert conditioning procedures involve the use of visualized imagery and are designed to work according to operant conditioning principles. When working with cooperative clients…

  10. Adaptability of Photo-Thermo Sensitive Genic Male Sterile Rice Line to Climate Condition in China%我国主要水稻光温敏核不育系类型的气候适应性

    Institute of Scientific and Technical Information of China (English)

    卢兴桂; 袁潜华; 姚克敏; 刘梅

    2001-01-01

    针对夏季低温对我国两系杂交稻制种生产的严重威胁,用1997~1998年由三亚、武昌、贵阳、南京4个生态点组成的“新不育系联合生态鉴定”试验资料,分析了以培矮64S为代表的实用低温敏类型不育系和以N5088S为代表的实用光敏类型不育系的育性光温影响规律。结果表明,培矮64S的育性受温度影响,育性稳定性较差,下限温度指标年际间和地区间变化较大;N5088S育性主要受日长影响,其临界光长同一地年际间差异小,但地区间差异较大。同时,用1951~1992年逐日平均气温和理论日长资料,分析和评价了我国南方稻区(18°14′~34°17′N)的三亚、南京、广州、福州、长沙、杭州、南京、高邮、徐州等9个城市的光温特征及其时空规律。在此基础上,从生态角度提出了克服夏季低温危害两系杂交稻制种的三项生态技术措施,一是要根据气候规律正确选择适宜的制种地区和季节;二是华中双季稻区应改秋制为春制或选择山区单季稻区秋制;三是应全面评价温敏和光敏类型不育系的特点,因气候合理地利用现有的水稻不育系资源。%Based on the data from the experiment “joint ecologicaldetermination of new sterile lines” at Sanya, Wuchang, Nanjing, and Guiyang in 1997-1998, fertility variation of Pei′ai64S(a low temperature sensitive sterile line) and N5088S(a photoperiod sensitive sterile line)under different daylength and temperature condition was analyzed. The results showed that the fertility of Pei′ai64S was dominantly affected by temperature and unstable,the critical low temperature for fertility conversion were different among years and cities; and that of N5088S was dominantly affected by daylength, difference of critical daylength for fertility conversion was small in different years in a city,but large in different cities. According to daily mean

  11. Tracheostomy care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000076.htm Tracheostomy care To use the sharing features on this ... through your nose and mouth. Caring for Your Tracheostomy Once the hole in your neck is not ...

  12. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  13. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  14. Pin care

    Science.gov (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. www.aast.org/discharge-instructions-for-wound-cares . Accessed May 13, 2016.

  15. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens

    2007-01-01

    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  16. Agencia de autocuidado y factores básicos condicionantes en adultos mayores Autocuidado e fatores básicos condicionantes em adultos maiores Self-care agency and basic conditioning factors in the elderly

    Directory of Open Access Journals (Sweden)

    Alba Rosa Fernández

    2011-07-01

    participacao de 240 adultos maiores, feito em julho de 2009. A Escala ASA foi utilizada para valorar a capacidade de autocuidado e a ficha de dados sócio-demográficos e de saúde (DSDS. Os dados foram analisados no SPSS, versao 15.0. Resultados: A média total ASA dos adultos maiores foi de 46,8; mostrando um desvio padrao de 4,6. 99,6% da populacao apresentaram uma "baixa capacidade do autocuidado", numa faixa de 24 a 59 pontos. A média de idade foi de 71,6 anos; o desvio padrao foi de 6,7; 48,8% da populacao pertenciam á faixa etária de 60-70 anos; 76,7% eram mulheres, 49,2% nao tinham educacao escolar; 42,5% eram viúvos, 70,4% trabalhavam como empregados domésticos; 53,3% pertenciam ao estrato social 1; 73,8% moravam com as suas famílias. 21,7% estavam afiliados ao Caprecom. 23,8% apresentaram problemas renais; 71,3% reportaram deficiencias visuais; 78,3% apresentavam uma média de tensao arterial normal e 84,2% apresentavam um pulso normal. 72% das femeas da populacao apresentam um diámetro abdominal que as poe em risco (mais de 80 cm. Conclusáo: Os adultos maiores apresentaram umabaixa capacidade de autocuidado e dos fatores básicos condicionantes que precisam da atencao da enfermaria.Self-care agency is the capacity of an individual to take care of him/ herself; elements of the individual or the environment he/she lives in may have influence, these are called basic conditioning factors. Purpose: To determine the self-care agency and basic conditioning factors in old patients with hypertension in Tunja, Boyacá, Colombia. Methods: Descriptive cross section study with 240 senior patients carried out in July 2009. ASA scale was used to assess self-care agency and the social-demographic and health data card (DSDS. Data were analyzed in SPSS, version 15.0. Results: The total ASA mean of seniors was 46,8, standard deviation of 4,6; 99,6% showed "low self-care agency", within a range of 24 to 59 points. Average age was 71,6, standard deviation of 6,7; 48,8% were

  17. Surveillance and recipients care in stable condition

    Institute of Scientific and Technical Information of China (English)

    John J. Curtis

    2011-01-01

    @@ For decades now, transplant physicians, during follow-up of successfully transplanted renal failure patients, have ordered frequent checks of the serum creatinine and urinalysis.1 These remain commonplace tools. Blood pressure measurement is preformed on every clinic visit along with a check of body weight and a check for edema.

  18. Caring for Kids With Medical Conditions

    Science.gov (United States)

    ... others have learning problems and delays in their development. Ask parents: If your child uses a wheelchair, leg braces, or walker, does ... to suggest activities for your time with their child. You can start with simple puzzles or coloring and plan other things to do ...

  19. Many diseases, one model of care?

    NARCIS (Netherlands)

    Albreht, T.; Dyakova, M.; Schellevis, F.G.; Broucke, S. van den

    2016-01-01

    Patients with multiple chronic conditions (multimorbidity) have complex and extensive health and social care needs that are not well served by current silo-based models of care. A lack of integration between care providers often leads to fragmented, incomplete, and ineffective care, leaving many pat

  20. 32 CFR 564.37 - Medical care.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from...

  1. Condicionantes en la utilización de los servicios de atención primaria: Evidencias empíricas e inconsistencias metodológicas Factors conditioning primary care services utilization: Empirical evidence and methodological inconsistencies

    Directory of Open Access Journals (Sweden)

    M. Sáez

    2003-10-01

    : problemas de diseño, errores de medida, errores de especificación y métodos estadísticos inadecuados. Como vías de solución citaríamos el diseño de cuasi experimentos, la utilización de grandes bases de datos administrativos, así como de fuentes de datos primarios (diseño; la distinción entre distintos tipos de utilización y entre unidades de análisis alternativas a la visita, y la corrección de errores de medida en las variables explicativas (errores de medida; la consideración de variables explicativas relevantes (errores de especificación, y la utilización de modelos multinivel (métodos estadísticos inadecuados.Introduction: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. Factors conditioning use: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. Methodological inconsistencies: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain

  2. The role of sensitization in musculoskeletal shoulder pain

    OpenAIRE

    John Borstad; Christopher Woeste

    2015-01-01

    Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studie...

  3. Advance care directives

    Science.gov (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  4. Situación y perspectivas laborales de los técnicos de salud de atención primaria de Cataluña Working conditions of public health workers in the primary care in Catalonia, Spain

    Directory of Open Access Journals (Sweden)

    Maria Salut Martínez Ferrer

    2007-06-01

    Full Text Available Objetivos: Explorar la situación laboral de los técnicos de salud adscritos a las unidades docentes de medicina de familia y comunitaria de Cataluña. Métodos: Estudio transversal. Resultados: De 53 posibles técnicos de salud, se obtuvieron 40 respuestas, 29 completas. Más de la mitad de los técnicos de salud del Institut Català de la Salut son interinos. Sus principales actividades son la docencia, el apoyo metodológico a la investigación y la evaluación de servicios y personal sanitario. Desean mayor definición de sus funciones y mejorar sus condiciones de trabajo. Aunque una pequeña proporción considera muy difícil la coordinación en la salud pública, la mayoría muestra disposición a colaborar. Conclusiones: La inestabilidad laboral, las mejoras salariales y la definición de funciones son prioritarias para los técnicos de salud. Consideran deseable la coordinación de la atención primaria con los servicios de salud pública.Objective: To describe the working conditions and tasks of health workers in the health training unit of family medicine in Catalonia, Spain. Methods: Cross-sectional study. Results: Fifty-three public health workers were located. Forty responses were obtained, of which 29 were complete. More than half the health technicians in the Catalan Health Service had temporary contracts. Their main tasks were teaching, providing methodological assistance in research, and auditing healthcare services and healthcare workers. Health technicians wanted more precise job definition and better working conditions. Although a small proportion believed coordination of primary care and public health to be very difficult, most would take part in it. Conclusions: The main issues for public health workers were work instability, better salaries, and greater job definition. Coordination between primary care and public health was considered desirable.

  5. Condicionantes estruturais da regionalização na saúde: tipologia dos Colegiados de Gestão Regional Structural conditions for regionalization in health care: typology of Regional Management Boards

    Directory of Open Access Journals (Sweden)

    Ana Luiza d'Ávila Viana

    2010-08-01

    Full Text Available O atraso na implementação da estratégia da regionalização e a fragilidade de iniciativas combinadas de descentralização e regionalização no Brasil requerem explicação. O artigo levanta algumas hipóteses para elucidar essa intricada questão e analisa os condicionantes estruturais do processo de regionalização em curso nos estados. Para isso, elabora uma tipologia nacional das regiões de saúde que as diferenciam segundo graus de desenvolvimento econômico, social e características da rede de saúde, dos municípios que compõem os Colegiados de Gestão Regional (CGR formalmente implantados até janeiro de 2010. Para a construção da tipologia, adotaram-se os modelos de análise fatorial e de análise de agrupamentos (cluster analysis. Foram identificados cinco grandes grupos socioeconômicos de CGR, descritos de acordo com sua distribuição regional, população, despesa em saúde, perfil da oferta (incluindo mix público e privado e cobertura de serviços de saúde. Os resultados encontrados servem como norteadores da constituição de redes de atenção à saúde e de novas iniciativas no campo regional, de forma a aprimorar a política de regionalização e favorecer a construção de instrumentos de regulação diversificados, flexíveis e, sobretudo, mais ajustados às realidades regionais.An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR, formally implanted by January

  6. Point-of-care testing of HbA1c in diabetes care and preventable hospital admissions

    DEFF Research Database (Denmark)

    Kristensen, Troels; Rose Olsen, Kim

    there is a link between preventable hospital admissions and POCT of HbA1c in general practice. Preventable hospital admissions were assessed through the ambulatory care sensitive conditions (ACSCs) classification of hospital admissions. We include independent variables such as gender, age, ethnicity......Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes and enhanced clinical efficiency with fewer patient visits and subsequent reductions in hospitalizations and costs. In 2008, the Danish regulators agreed to create a new tariff...... for the remuneration of POCT of HbA1c in primary care. Aim: The aim of this study is to assess whether there is an association between the use of POCT of HbA1c and preventable hospital admissions among diabetes patients in general practice. Method: We apply logistic regression analyses to examine whether...

  7. 产后抑郁症产妇家庭关怀度与健康状况的相关性研究%Correlation research on family care degree and health condition of postpartum depression

    Institute of Scientific and Technical Information of China (English)

    李秀梅; 陈登宏; 张磊

    2014-01-01

    Objective To explore the correlation between family care degree and health condition of the puerperas with postpartum depression .Methods Totals of 98 puerperas with postpartum depression were evaluated by family APGAR index and self-rated health measurement scale ( SRILMS) , they were compared with 98 normal postpartum puerperas in same phase ,then analyze the correlation between them .Results The scores of APGAR[(6.75 ±2.27) vs (8.26 ±2.14)],and SRHMS[(274.73 ±55.61) vs (313.84 ±51.58)]of the puerperas with postpartum depression were significantly lower than that of the normal postpartum puerperas ( t=4.79, 5.11,respectively;P<0.01).Correlation analysis showed that positive correlation was found between APGAR and SRHMS(P<0.01).Conclusions The health condition and family care degree of the puerperas with postpartum depression is worse .While improving family care degree is conducive to prevent postpartum depression happening , and promote physical and mental rehabilitation of them .%目的:探讨产后抑郁症家庭关怀度与健康状况的相关性。方法采用家庭关怀度指数量表( APGAR)和自测健康评定量表( SRHMS)对98例产后抑郁症产妇进行测评,并与相匹配的98例正常产后产妇进行比较,分析其相关性。结果产后抑郁症产妇APGAR和SRHMS总分分别为(6.75±2.27),(274.73±55.61)分,明显低于正常产后产妇的(8.26±2.14),(313.84±51.58)分,差异有统计学意义( t分别为4.79,5.11;P<0.01);相关分析显示,APGAR评分各维度与SRHMS各维度均呈正相关(P<0.01)。结论产后抑郁症产妇健康状况与家庭关怀度较差,提高家庭关怀度有助于预防产后抑郁症的发生,促进身心康复。

  8. Symptom management in palliative care and end of life care.

    Science.gov (United States)

    Bookbinder, Marilyn; McHugh, Marlene E

    2010-09-01

    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  9. Concept caring in nursing

    Directory of Open Access Journals (Sweden)

    Lenka Drahošová

    2016-05-01

    Full Text Available Aim: The aim of this literature review was to search for qualitative studies focusing on the concept of caring in nursing, to analyse them and to synthesize knowledge that concerns the definition of the concept of caring in nursing from the point of view of nurses and patients. Design: Review. Methods: Qualitative studies were searched for systematically in the electronic databases Academic Search Complete (EBSCO, CINAHL, Medline, Science Direct, and the Wiley Library Online, according to set criteria and defined key words for the period 1970-2015. Seven selected articles were analysed after selection of documents with the aid of a sorting chart. Results: Nurses understand caring in nursing as a relationship with patients which is characterised on the nurses' part by an individual and empathetic approach, attentiveness, experience and sensitivity. Through caring, active communication takes place, providing information which reduces anxiety and leads to the breaking down of barriers. This relationship helps protect patients' autonomy, dignity and comfort. It requires experience on the part of nurses, and it is influenced by the environment. The nurses' personal qualities (what professional knowledge, attitudes and skills they have and their availability, reliability, and emotional and physical support are important to patients. Conclusion: The concept of caring is a content specific interpersonal process which is characterized by the professional knowledge, skills, personal maturity, and interpersonal sensitivity of nurses, which result in the protection, emotional support, and the meeting of bio-psycho-social needs of patients. The results of the overview study could contribute to an explanation and understanding of the nature of caring as a fundamental feature of the discipline of nursing.

  10. Primary care for refugees.

    Science.gov (United States)

    Eckstein, Barbara

    2011-02-15

    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  11. Generalist palliative care in hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi

    2016-01-01

    Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim......: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies...... hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use...

  12. The chronic disease management in community health service institutions based on Innovative Care for the Chronic Conditions Framework%基于ICCC框架的社区卫生服务机构慢性病管理研究

    Institute of Scientific and Technical Information of China (English)

    袁莎莎; 王芳; 李陈晨; 刘利群; 周巍; 衡驰; 杨婷

    2015-01-01

    Objective:To study the chronic disease management’s key factors in community health service insti-tution based on the Innovative Care for Chronic Conditions Framework ( ICCC ) . Methods: The purposive sampling method was adopted. Twelve community health service centers were selected as the field survey sites in Beijing, Shanghai, Zhengzhou and Chengdu. During the key factors description at macro-, meso-and micro-level in the IC-CC framework, thematic framework analysis was used to describe the key factors at maro-, meso-and micro level in the ICCC framework. Results:From the community health institutions’ perspective, the key factors at meso level in the ICCC framework played a better role in the management of chronic conditions while the key factors in both macro and micro level still lacked. Conclusion:Based on the ICCC framework, the management of chronic diseases needs to emphasize the cooperation with relevant departments outside the health area and legislative strategies at macro level, the ability of community supporters to mobilize and coordinate resources at meso level and the improvement of self-management skills for the patients with chronic diseases.%目的::以世界卫生组织提出的慢性病创新照护框架( Innovative Care for Chronic Conditions Frame-work, ICCC)为理论基础,从社区卫生服务机构角度出发,分析慢性病管理相关要素的实现现状。方法:采取目的抽样,选取北京市、上海市、郑州市、成都市共12家社区卫生服务中心进行现场调查。采用主题框架法,围绕ICCC框架提出的宏观—中观—微观三层面的关键要素展开分析。结果:基于ICCC框架,从社区卫生服务机构角度来看,以卫生保健组织为代表的中观层面要素功能发挥较好,宏观和微观层面要素缺乏。结论:基于ICCC框架,慢性病管理需在宏观层面加强与卫生系统外相关部门的协作及相关立法;中观层面需加强社区资源或社区

  13. Supportive Care.

    Science.gov (United States)

    Olsen, Pia Riis; Lorenzo, Rosalía

    2016-01-01

    This chapter takes its point of departure in psychosocial aspects of supportive care in adolescent and young adult cancer care. The purpose is to describe some of the challenges that these young people face following a cancer diagnosis and guide healthcare professionals in how to provide care that improves the quality of life. In most hospitals and healthcare systems, adolescents and young adults are cared for and treated in settings for children or adults. Accordingly, healthcare professionals may lack attention to and knowledge about what characterize young peoples' life situation, their special needs and how to meet them. The topics we include in the chapter are the following: the youth friendly environment, social support and social network, parents, information during a psychosocial crisis event, the use of HEADSS, peer support, fertility, body image and self-esteem, after treatment and future challenges and palliative and end of life care. PMID:27595353

  14. Mechanisms of multiple chemical sensitivity.

    Science.gov (United States)

    Winder, Chris

    2002-03-10

    Sensitivity to chemicals is a toxicological concept, contained in the dose-response relationship. Sensitivity also includes the concept of hypersensitivity, although controversy surrounds the nature of effects from very low exposures. The term multiple chemical sensitivity has been used to describe individuals with a debilitating, multi-organ sensitivity following chemical exposures. Many aspects of this condition extend the nature of sensitivity to low levels of exposure to chemicals, and is a designation with medical, immunological, neuropsychological and toxicological perspectives. The basis of MCS is still to be identified, although a large number of hypersensitivity, immunological, psychological, neurological and toxicological mechanisms have been suggested, including: allergy; autosuggestion; cacosomia; conditioned response; immunological; impairment of biochemical pathways involved in energy production; impairment of neurochemical pathways; illness belief system; limbic kindling; olfactory threshold sensitivity; panic disorder; psychosomatic condition; malingering; neurogenic inflammation; overload of biotransformation pathways (also linked with free radical production); psychological or psychiatric illness; airway reactivity; sensitisation of the neurological system; time dependent sensitisation, toxicant induced loss of tolerance. Most of these theories tend to break down into concepts involving: (1) disruption in immunological/allergy processes; (2) alteration in nervous system function; (3) changes in biochemical or biotransformation capacity; (4) changes in psychological/neurobehavioural function. Research into the possible mechanisms of MCS is far from complete. However, a number of promising avenues of investigation indicate that the possibility of alteration of the sensitivity of nervous system cells (neurogenic inflammation, limbic kindling, cacosomia, neurogenic switching) are a possible mechanism for MCS.

  15. Multiple Chronic Conditions Among Medicare Beneficiaries...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Individuals with multiple chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment....

  16. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla

    2014-07-01

    Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

  17. Providing Palliative Care to LGBTQ Patients.

    Science.gov (United States)

    Barrett, Nina; Wholihan, Dorothy

    2016-09-01

    Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care. PMID:27497022

  18. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela

    2015-03-01

    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  19. Primary care and ophthalmology in the United Kingdom

    OpenAIRE

    Riad, S F; Dart, J K G; Cooling, R J

    2003-01-01

    The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, ac...

  20. Coordinating Care for Children with Special Health Care Needs

    OpenAIRE

    Stephanie Peterson; Shanna Shulman; Henry Ireys

    2007-01-01

    This brief, the fourth in a series on critical issues involved in caring for children with special health care needs, notes that nearly three-quarters of parents who need professional care coordination services for their child say they do not get enough help—if they get any at all. Moreover, one-third of those who do get help are not fully satisfied with the quality of services they receive. Although many health plans coordinate care for their adult members with chronic conditions and disab...

  1. Multidisciplinary Care.

    Science.gov (United States)

    Daly, Megan E; Riess, Jonathan W

    2016-01-01

    Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care. Well-integrated multidisciplinary care may reduce treatment delays, improve cancer-specific outcomes, and enhance quality of life. We address key topics and areas of ongoing investigation in multidisciplinary decision making at each stage of the lung cancer treatment course for early-stage, locally advanced, and metastatic lung cancer patients. PMID:27535399

  2. Caring Encounters

    Science.gov (United States)

    Gunn, Alyson

    2012-01-01

    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  3. 重症监护病房念珠菌感染情况及药敏分析%Analysis of Candida infections and drug sensitivity in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    贾磊; 郁慧杰; 陆锦琪; 马燮峰; 刘宇婷; 张玉琦; 蔡莹

    2014-01-01

    目的:研究重症监护病房(ICU)患者念珠菌感染分布及耐药情况。方法采用回顾性研究方法,选择2011年1月至2013年12月浙江省嘉兴市第一医院ICU收治的危重病患者,收集送检的痰液、尿液、血液、腹水、胆汁等标本念珠菌培养呈阳性的资料,对3年来ICU念珠菌感染情况、阳性标本分布、不同念珠菌分布情况及对抗真菌药物的耐药性等进行分析。结果2011年至2013年ICU共入住患者2412例次,念珠菌感染407例(16.9%),3年间念珠菌感染率呈逐年上升趋势〔2011年至2013年念珠菌检出率分别为:13.4%(77/573)、16.1%(146/907)、19.7%(184/932)〕,差异有统计学意义(P<0.01)。407株念珠菌来自痰液166株(占40.8%),尿液157株(占38.6%),腹水53株(占13.0%),血液13株(占3.1%),胆汁11株(占2.7%),其他7株(占1.7%)。菌属分布主要是白色念珠菌(174株)、光滑念珠菌(131株)、热带念珠菌(83株)、近平滑念珠菌(5株)、克柔念珠菌(12株)等,也检出少见的葡萄牙念珠菌和解脂念珠菌(2株)。从2011年至2013年白色念珠菌、光滑念珠菌、热带念珠菌对氟康唑、伊曲康唑、伏立康唑等抗菌药物的耐药性2013年最高,2012年最低,对两性霉素B的耐药率均为0,对伊曲康唑的耐药率最高(分别为10.9%、27.8%、9.6%),其次是伏立康唑(分别为6.6%、11.0%、0)、氟康唑(分别为4.7%、7.4%、1.9%),近平滑念珠菌、克柔念珠菌、葡萄牙念珠菌和解脂念珠菌对两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率均为0。结论 ICU念珠菌感染率呈上升趋势,主要集中在呼吸道和泌尿道,对伊曲康唑的耐药率最高。%Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical

  4. Analysis of Candida infections and drug sensitivity in intensive care unit%重症监护病房念珠菌感染情况及药敏分析

    Institute of Scientific and Technical Information of China (English)

    贾磊; 郁慧杰; 陆锦琪; 马燮峰; 刘宇婷; 张玉琦; 蔡莹

    2014-01-01

    Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4

  5. Integrating Palliative Care into Primary Care.

    Science.gov (United States)

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  6. Final Report, The Teaching Parents Study: Pan-Britain, mixed methods study of multidisciplinary teams teaching parents, and parents learning to manage, home based care of long-term childhood kidney conditions

    OpenAIRE

    Veronica Swallow, Ruth Nightingale, Davina Allen, Julian Williams, Trish Smith, Jean Crosier, Heather Lambert, Leila Qizalbash, Lucy Wirz, Nicholas JA Webb, Cat Mercer, Laura Crowther.

    2012-01-01

    Background: Care of children and young people (children) in the 12 children’s kidney units in England, Scotland and Wales is managed by multidisciplinary teams (MDTs) comprising professionals such as clinical psychologists, dieticians, doctors, nurses, pharmacists, play workers, social workers, and therapists. Within the constraints of treatment regimens it is in children’s best interests for them to be cared for at home whenever possible1-4. Professionals therefore, spend considerable time ...

  7. Wound Care in Primary Health Care

    OpenAIRE

    Nail Ersoz; Ismail Hakki Ozerhan; Fatih Zor

    2008-01-01

    Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000): 71-74

  8. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull. 2008; 7(1: 71-74

  9. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000: 71-74

  10. Mental health collaborative care and its role in primary care settings.

    Science.gov (United States)

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

    2013-08-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

  11. Mental health collaborative care and its role in primary care settings.

    Science.gov (United States)

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

    2013-08-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

  12. Integration of healthcare rehabilitation in chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne; Høst, Dorte; Schnor, Helle;

    2010-01-01

    of rehabilitation programmes in four conditions. DESCRIPTION OF CARE PRACTICE: FOUR MULTIDISCIPLINARY REHABILITATION INTERVENTION PROGRAMMES, ONE FOR EACH CHRONIC CONDITION: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented...... during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. CONCLUSION AND DISCUSSION: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions...

  13. Neurocritical care update.

    Science.gov (United States)

    Kuroda, Yasuhiro

    2016-01-01

    This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition. Continuous electroencephalogram monitoring is an essential tool for detecting nonconvulsive status epilepticus in the intensive care unit (ICU). Neurocritical care, including advanced hemodynamic monitoring, is a fundamental approach for delayed cerebral ischemia following subarachnoid hemorrhage. We must be mindful of the high percentage of ICU patients who may develop sepsis-associated brain dysfunction. PMID:27239312

  14. Caring for Latino patients.

    Science.gov (United States)

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients. PMID:23317025

  15. Critical issues in burn care.

    Science.gov (United States)

    Holmes, James H

    2008-01-01

    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  16. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

    Directory of Open Access Journals (Sweden)

    Paula Alvarenga de Figueiredo

    2016-01-01

    Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

  17. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal1

    Science.gov (United States)

    de Figueiredo, Paula Alvarenga; Alvim, Neide Aparecida Titonelli

    2016-01-01

    Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing. PMID:27192418

  18. Mental Health Collaborative Care and its Role in Primary Care Settings

    OpenAIRE

    Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M; Bauer, Mark S

    2013-01-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. Th...

  19. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve. PMID:26022525

  20. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  1. How to communicate: ''I care''

    International Nuclear Information System (INIS)

    In the competitive health care environment, organizations are concerned with patients' perceptions of health care received. The nurse in the radiology setting has the unique opportunity to be involved with all patient populations. In the area of verbal-nonverbal communication, the nurse often responds automatically without always being sensitive to how the response is perceived by the other person. This session is a review of the health care provider's need for basic sensitivity to others and an ability to respond effectively to emotional issues. The objectives of this session are to enable readers to (1) identify appropriate methods of approaching a person in a wheelchair, (2) state basic fundamental ideas when communicating and working with a confused or head-injured person, and (3) identify appropriate words to project positive mental images for people who happen to have a disability

  2. [Palliative care in neurology].

    Science.gov (United States)

    Provinciali, Leandro; Tarquini, Daniela; De Falco, Fabrizio A; Carlini, Giulia; Zappia, Mario; Toni, Danilo

    2015-07-01

    Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the "end of life" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance. PMID:26228722

  3. Segmenting the mental health care market.

    Science.gov (United States)

    Stone, T R; Warren, W E; Stevens, R E

    1990-03-01

    The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.

  4. Home Care

    Science.gov (United States)

    ... care is especially useful for persons who need nursing, therapy, or aide services. You may need help if you are dealing with one or more of the following: You have trouble getting around (for example, after a hospital stay or an accident) You have wounds that need to be cleaned, ...

  5. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. PMID:22176544

  6. [DIE TAKING CARE].

    Science.gov (United States)

    Re, Cecilia

    2016-02-01

    Under the paradigm of complex thought, Edgar Morin and the pedagogy of the oppressed by Paulo Freire we describe and explain briefly the reasons of the squalid conditions in which develops the work of caring, which is not only an art and a science. The review of scientific literature, as well as the stories of life, support the need for a pedagogical reference change in vocational training programs.

  7. Reliability of medical audit in quality assessment of medical care

    Directory of Open Access Journals (Sweden)

    Camacho Luiz Antonio Bastos

    1996-01-01

    Full Text Available Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6, depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

  8. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  9. [Take care of a child, one work like any other?].

    Science.gov (United States)

    Bloch, Françoise

    2010-01-01

    This article has its roots in the basic contradictions, which go back to the eighteenth and nineteenth centuries, between the self-interest and the care of others, exemplified by the delegation of responsibility for the care of children and other vulnerable persons. This splitting of human life-supporting activities has sealed women's dependence on men by setting off the lucrative area from the private, non-lucrative sphere of activities. These contradictions become paradoxical as soon as we consider the delegation of responsibility for the care of a child to someone not related to the child. This article addresses the question of how the child's developmental needs can be met without damage to his/her sensitivity, and his/her perception of others or of the cooperation involved. As soon as it is born, the child, a thoroughly interactive being, discerns the relationships it entertains with those who are in charge of him/her. The persons - mostly women - who take care of the child are not interchangeable, since they bring their own subjectivity into their dealings with the child and this is reciprocal. The women's skills, frequently thought to be “undefinable”, but which many women, whether related or not to the child, have developed or should develop, are brought into play and are either transmitted or acquired in the course of their care of the child; these skills are not by nature “feminine skills”, but they require a great deal of reactivity and sensitivity and therefore, many child professionals, mothers' aids and children's care-takers in the home are hurt and insulted by the low esteem in which they are held. These skills and human qualities, which are the result of feelings more than of formalised knowledge, techniques or theories - albeit these are also necessary - make child care and child rearing an art. These skills seem to be in total contradiction with those that are current in the world of labour, where the tempo of work, flexibility of working

  10. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  11. Truth conditions

    Institute of Scientific and Technical Information of China (English)

    张丽

    2009-01-01

    Truth conditions are used to determine whether a sentence is true or not in semantics. This article gives some examples both in English and Japanese to analyze truth conditions. Besides, the importance and the application of truth conditions are also mentioned.

  12. Does managed care reduce health care expenditure? Evidence from spatial panel data.

    Science.gov (United States)

    Ehlert, Andree; Oberschachtsiek, Dirk

    2014-09-01

    Similar to, for example, the US, Switzerland or Great Britain the German health care sector has recently undergone a series of reforms towards managed care. These measures are intended to yield both a higher quality of care and cost containment. In our study we ask whether managed care reduces health care expenditure at the market level. We apply a macroeconomic evaluation approach based on a regional panel data set which is as yet unique in the context of managed care. Econometrically, we account for both unobserved heterogeneity and spatial dependence, i.e. regional interrelations in health care. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending, in particular through regional spillover effects. PMID:24691774

  13. Longitudinal Magnetic Resonance Imaging-Based Assessment of Vascular Changes and Radiation Response in Androgen-Sensitive Prostate Carcinoma Xenografts under Androgen-Exposed and Androgen-Deprived Conditions

    Directory of Open Access Journals (Sweden)

    Kathrine Røe

    2010-10-01

    Full Text Available Prostate cancer (PCa patients receive androgen-deprivation therapy (ADT to reduce tumor burden. However, complete eradication of PCa is unusual, and recurrent disease is evident within approximately 2 years in high-risk patients. Clinical evidence suggests that combining ADT with radiotherapy improves local control and disease-free survival in these patients compared with radiotherapy alone. We investigated whether vascularization of androgen-sensitive PCa xenografts changed after ADT and whether such therapy affected radiation response. CWR22 xenografts received combinations of ADT by castration (CWR22-cas and 15 Gy of single-dose irradiation. At a shortest tumor diameter of 8 mm, vascularization was visualized by dynamic contrast-enhanced magnetic resonance imaging before radiation and 1 and 9 days after radiation. Voxel-wise quantitative modeling of contrast enhancement curves extracted the hemodynamic parameter Ktrans, reflecting a combination of permeability, density, and blood flow. Tumor volumes and prostate-specific antigen (PSA were monitored during the experiment. The results showed that Ktrans of CWR22-cas tumors 36±4 days after ADT was 47.1% higher than Ktrans of CWR22 tumors (P = .01. CWR22-cas tumors showed no significant changes in Ktrans after radiation, whereas Ktrans of CWR22 tumors at day 1 decreased compared with pretreatment values (P = .04 before a continuous increase from day 1 to day 9 followed (P = .01. Total PSA in blood correlated positively to tumor volume (r = 0.59, P < .01. In conclusion, androgen-exposed xenografts demonstrated radiation-induced reductions in vascularization and tumor volumes, whereas androgen-deprived xenografts showed increased vascularization and growth inhibition, but no significant additive effect of radiation.

  14. Designing self-care for everyday life

    DEFF Research Database (Denmark)

    Verdezoto, Nervo; Nunes, Francisco; Grönvall, Erik;

    2014-01-01

    Managing chronic conditions can be challenging. People in such conditions, and the people around them, have to: deal with symptoms, adapt to the resulting disability, manage emotions, and change habits to keep the condition under control. Self-care technologies have the potential to support self-care...... and mediate the relationship between patients (and caregivers) and the condition. However, these technologies often disregard the complexity of the settings in which they are used and fail to become integrated in everyday life. In this workshop we will discuss how to design self-care technologies...

  15. Workshop: integration of care at the interface of primary and secondary care: work in progress.

    NARCIS (Netherlands)

    Zee, J. van der

    2010-01-01

    Background and aim: Existing health care arrangements do not always provide a well-organized response to health problems occurring in society. Inadequate coordination of care for people with chronic conditions or elderly in need for home care services provide examples of important integration issues

  16. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    NARCIS (Netherlands)

    Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.

    2011-01-01

    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b

  17. Self-Care Technologies in HCI

    DEFF Research Database (Denmark)

    Nunes, Francisco; Verdezoto, Nervo; Fitzpatrick, Geraldine;

    2015-01-01

    Many studies show that self-care technologies can support patients with chronic conditions and their carers in understanding the ill body and increasing control of their condition. However, many of these studies have largely privileged a medical perspective and thus overlooked how patients...... and carers integrate self-care into their daily lives and mediate their conditions through technology. In this review, we focus on how patients and carers use and experience self-care technology through a Human-Computer Interaction (HCI) lens. We analyse studies of self-care published in key HCI journals...... and conferences using the Grounded Theory Literature Review (GTLR) method and identify research trends and design tensions. We then draw out opportunities for advancing HCI research in self-care, namely, focusing further on patients’ everyday life experience, considering existing collaborations in self-care...

  18. How Sensitively Timed Are Sensitive Periods?

    Science.gov (United States)

    Zener, Rita Schaefer

    2003-01-01

    Reviews Maria Montessori's view of sensitive periods and examines the kinds of help needed from adults: an open mind, specific help from a prepared learning environment, and challenges presented at the right time. Stresses the universality of sensitive periods and their connection to brain development. Focuses on the unconscious nature and…

  19. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  20. 25 CFR 20.331 - What is Adult Care Assistance?

    Science.gov (United States)

    2010-04-01

    ... SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.331 What is Adult Care Assistance... require personal care and supervision due to advanced age, infirmity, physical condition, or mental... 25 Indians 1 2010-04-01 2010-04-01 false What is Adult Care Assistance? 20.331 Section...

  1. Living Conditions and Care Service Needs of the Elderly People in Urban Communities:Take the City of Langfang for Example%城市社区老年人生活状况及养老服务需求研究--以廊坊市为例

    Institute of Scientific and Technical Information of China (English)

    孙金明

    2015-01-01

    近十年,廊坊市老龄人口比例呈现不断上升趋势,市区老年人口结构呈现金字塔形,已经进入老年人口快速增长阶段,面临诸多的养老问题。通过对廊坊城市社区老年人生活状况及养老服务需求进行调查分析可以发现,家庭养老虽然弱化但仍是主流养老方式,社会化养老服务缺口大、层级较低,居家养老服务有很大发展潜力。%Over the past decade, the proportion of the aging population presents a rising trend in Langfang, with the urban elderly pop-ulation showing a pyramid structure and rapid growth, and many elderly service issues have appeared. Investigation and analysis of the living conditions and care service needs of the elderly people in urban communities has found that although family support is gradually weakening, it still is the mainstream of elderly care service. There is a large gap and low level in social elderly care service. Therefore, residential elderly care service has great potential for development.

  2. Princeton HealthCare System name reflects comprehensive services. New brand identity focuses on 'Redefining Care'.

    Science.gov (United States)

    Botvin, Judith D

    2004-01-01

    The Medical Center at Princeton, Princeton, N.J., introduced its new name last June, both to its community and its internal stakeholders. It is now known as Princeton HealthCare System, a name chosen to reflect its growth and diversity. It's being branded as a unique institution that combines the sensitive, caring serice of a community hospital with the sophisticated care of a teaching hospital. PMID:15162577

  3. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    Science.gov (United States)

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  4. 用显示器测量办公亮度环境下的人眼对比度敏感视觉特性%Measurement Contrast Sensitivity of Human Vision System under Different Office Ambience Luminance Condition on the CRT Display

    Institute of Scientific and Technical Information of China (English)

    姚军财

    2012-01-01

    对比度敏感是描述人眼视觉系统空间特性的主要指标之一,对比度敏感函数是反映不同条件下的对比度敏感与空间频率之间的关系.人眼对比度敏感数据的测量受到环境亮度较大的影响,为了研究常用办公环境条件下的人眼对比度敏感情况,对6位青年在环境亮度分别为153,312,470 cd/m2和暗室条件下,在距离为2米处观测11种空间频率的矩形光栅进行测量,光栅用显示器进行显示,其平均亮度分别为60和90 cd/m2.实验结果表明,对于相同频率的光栅,人眼对比度敏感程度随着环境亮度的增加而减小,而且人眼在暗室环境下比在办公环境条件下对亮度光栅更敏感;但是在观测平均亮度为60cd/m2的光栅时,人眼特殊地对在环境亮度为312 cd/m2的条件下更敏感.%The contrast sensitivity function (CSF) is one of important and special spatial characteristics of human vision system,which is to reflect the relation between the contrast sensitivity under different viewing condition and spatial frequency.Ambient luminance had much influence on the contrast sensitivity in the measurements.In order to investigate how the luminance of office lighting surround to a visual target affected the measurement of contrast sensitivity to rectangular gratings,six healthy young were examined under the ambient luminance of 153,312,470 cd/m2 and the dark room condition.Measurements were carried out on a CRT monitor for 11 spatial frequencies at a viewing distance of 2m.Tested grating patterns were with two kinds of average luminance of 60 and 90 cd/m2.Measurements results show that contrast sensitivity is reduced with ambient luminance increasing,and all contrast sensitivity under the lighting viewing condition was much smaller than one under the dark room viewing condition for the same frequency,but distinguishingly,observers are the most sensitive to gratings under the surround with the luminance of 312 cd/m2 when viewing

  5. Classical conditioning and pain: conditioned analgesia and hyperalgesia.

    Science.gov (United States)

    Miguez, Gonzalo; Laborda, Mario A; Miller, Ralph R

    2014-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

  6. Plasmonic paper: an emerging analytical platform for highly sensitive biosensors (Conference Presentation)

    Science.gov (United States)

    Singamaneni, Srikanth

    2016-03-01

    Plasmonic biosensors hold enormous potential for the development of low-cost, label-free, point-of-care biodiagnostics. However, two major challenges need to be overcome to reap the benefits of this class of biosensors: (i) state-of-the-art plasmonic biosensors either offer limited sensitivity or are impractical for real-world applications due to their poor stability and excessive cost; (ii) these biosensors rely on natural antibodies, which are high-cost and impose severe limitations in handling, storage and device integration. We demonstrate that a common filter paper can be transformed into a plasmonic sensing platform for highly sensitive and selective detection of trace levels of chemical and biological analytes. We also demonstrate that short peptides as biorecognition elements compared to larger antibodies as target capture agents offer several advantages. Using a bioplasmonic paper device, we demonstrate the selective and sensitive detection of the cardiac biomarker troponin I. The smaller sized peptide provides higher sensitivity and a lower detection limit using a bioplasmonic paper device. Furthermore, the excellent shelf-life and thermal stability of peptide-based plasmonic biosensors, which precludes the need for special storage conditions, makes it ideal for use in resource-limited settings. We also demonstrate plasmonic biosensors based on artificial antibodies by molecularly imprinting the plasmonic nanotransducers. Apart from significantly lowering the cost, these developments are critical for translating plasmonic sensors to point-of-care and resource-limited settings.

  7. Who cares!

    Institute of Scientific and Technical Information of China (English)

    老晃

    2013-01-01

    1有人再三怂恿,希望我能吐槽《富春山居图》,务求鞭辟入里,揭露丑恶真相。我舍不得,舍不得浪费纸。好吧,小吐一下。传说,在《富春山居图》开拍之前有心人提醒导演孙健君,剧本有硬伤,得改,例举一三三四……话没说完,孙勃然大怒,"Who cares!"这位目空一切的君王,他什么都不care,所以他花钱砸的那堆玩意儿,根本也不是电影。这就是真相。值得一说的,是此刻红得发紫,摸都摸不得的《小时代》。

  8. Health Care of the Elderly in Medically Disadvantaged Populations.

    Science.gov (United States)

    German, Pearl S.; And Others

    1978-01-01

    This study of three disadvantaged urban areas reports on the relationship between available resources and ambulatory health care. Findings indicate a high proportion of elderly receiving care for serious conditions but a sharp drop in care for less serious but potentially disabling conditions. (Author)

  9. Palliative wound care: principles of care.

    Science.gov (United States)

    Dale, Barbara; Emmons, Kevin R

    2014-01-01

    Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.

  10. Knowledge sharing behaviour and intensive care nurse innovation: the moderating role of control of care quality

    DEFF Research Database (Denmark)

    Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid

    2016-01-01

    Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little...... insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. Methods We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions...... of the questionnaire were used – one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Results Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care...

  11. Culture-sensitive psychotraumatology

    Directory of Open Access Journals (Sweden)

    Ulrich Schnyder

    2016-07-01

    Full Text Available Background: Although there is some evidence of the posttraumatic stress disorder (PTSD construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. Methods: The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. Results: As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. Conclusions: In summary

  12. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening...... the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives...

  13. Culture-sensitive psychotraumatology

    Science.gov (United States)

    Schnyder, Ulrich; Bryant, Richard A.; Ehlers, Anke; Foa, Edna B.; Hasan, Aram; Mwiti, Gladys; Kristensen, Christian H.; Neuner, Frank; Oe, Misari; Yule, William

    2016-01-01

    Background Although there is some evidence of the posttraumatic stress disorder (PTSD) construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. Methods The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. Results As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. Conclusions In summary, culture-sensitive

  14. Integrated care pathways and task shifting

    Directory of Open Access Journals (Sweden)

    Linda Panton

    2014-11-01

    Full Text Available Delivery of HIV care has evolved over the last 10 years, and nurse specialists are a driving force in developing new pathways to enhance patient care. Despite the continued rise in numbers of people living with HIV, the financial constraints on the NHS have unfortunately resulted in a reduction in service provision. Experienced nurses are integral to patient care management. They not only provide standardized care for stable patients, therefore increasing consultant capacity for the more complex medical patient, but have a degree of flexibility that allows newly diagnosed patients quick access to care and support. With a strong emphasis being placed on an integrated and collaborative multidisciplinary team approach, to ensure patients receive the same standard of care, Scotland's HIV centres follow an integrated care pathway. The nurse oversees the completion of this document and co-ordinates the pathway of care depending on the clinical need. Nurses develop and maintain necessary partnerships between primary care, specialist care, psychological services, social care and third sector support services. The nurse case load continues to expand and diversify. Stable patients may be maintained on therapy but are living with a stigmatized long-term chronic condition and rely on the nurse as a point of contact to access advice and support readily. The more chaotic and vulnerable clients with complex care needs require the nurse to co-ordinate their care, ensuring the appropriate agencies remain involved. Overseeing the transition of care to other units and tracing patients who are lost to follow up is also a necessity, as retention in care is paramount for the continued improvement in clinical outcomes. The contribution that specialist nurses make to the provision of HIV care is valuable and will continue to play a large role in the delivery of such care.

  15. [Promoting citizenship through nursing care].

    Science.gov (United States)

    Backes, Dirce Stein; Backes, Marli Stein; Erdmann, Alacoque Lorenzini

    2009-01-01

    This study is the result of the project: networks care and social entrepreneurship: the autonomy and social commitment of nurses. The purpose of this qualitative study is to comprehend the meaning of nursing care as a social enterprising practice. The Grounded Theory was used as a methodological reference and the interview, conducted with 35 participants as technique of data collection. Data codification led to the central theme: Viewing Nursing Care as a Social Enterprising Practice. This theme is complemented by the category, characterized the cause condition: the social integration through the creation a political identity that expresses your involvement. The results showed that is necessary to learn and have a deep dialogic knowledge. In order to consolidate popular participation as a citizenship ideal, a critical professional attitude, base don the combination of care with liberty, participation end autonomy. PMID:19597667

  16. [Promoting citizenship through nursing care].

    Science.gov (United States)

    Backes, Dirce Stein; Backes, Marli Stein; Erdmann, Alacoque Lorenzini

    2009-01-01

    This study is the result of the project: networks care and social entrepreneurship: the autonomy and social commitment of nurses. The purpose of this qualitative study is to comprehend the meaning of nursing care as a social enterprising practice. The Grounded Theory was used as a methodological reference and the interview, conducted with 35 participants as technique of data collection. Data codification led to the central theme: Viewing Nursing Care as a Social Enterprising Practice. This theme is complemented by the category, characterized the cause condition: the social integration through the creation a political identity that expresses your involvement. The results showed that is necessary to learn and have a deep dialogic knowledge. In order to consolidate popular participation as a citizenship ideal, a critical professional attitude, base don the combination of care with liberty, participation end autonomy.

  17. Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care

    DEFF Research Database (Denmark)

    Thorup, Charlotte Brun; Rundqvist, Ewa; Roberts, Christel;

    2012-01-01

    Scand J Caring Sci; 2011 Care as a matter of courage: vulnerability, suffering and ethical formation in nursing care The aim of the study was to explore nurses' experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care...... when they are confronted with the patient's vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient's appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process......, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland...

  18. Self-care practice of patients with arterial hypertension in primary health care

    Directory of Open Access Journals (Sweden)

    Cláudia Rayanna Silva Mendes

    2016-02-01

    Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.

  19. How sensitizing is chlorocresol?

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Hamann, K

    1984-01-01

    Chlorocresol is a biocide with widespread use in industry and pharmaceutical products. It is an occasional human contact sensitizer. The sensitizing potential of chlorocresol was judged strong using the guinea pig maximization test (GPMT) and doubtful in the less sensitive open epicutaneous test...

  20. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.